Adenocarcinoma of the prostate (CaP) in the Western world has become the most common noncutaneous human
tumor. CaP is also the second most important cause of
cancer deaths among the male population in the United States. Major progress was made in the past decade in better understanding this disease process, as well as in improved diagnostic accuracy. This improved diagnostic accuracy was due to wide application of
prostate-specific antigen (PSA), use of transrectal ultrasound (TRUS), and greater awareness among clinicians of CaP. The use of PSA in clinical practice has resulted in a sharp increase in the number of patients diagnosed with
capsule-confined
tumors. The optimal treatment for
capsule-confined CaP is in the process of being defined. Radical
prostatectomy in the United States is currently the most commonly applied treatment for younger patients. Excellent treatment results with a 10-year actuarial survival > 80% are readily obtainable in properly selected patients. Nerve-sparing procedures helped reduce the high incidence of
impotence that occurs in patients after radical
retropubic prostatectomy.
Radiotherapy remains the other curative treatment method in the management of CaP patients, with long-term survival rates similar to those reported in surgical series. Due to the problem of frequent preoperative
tumor understaging, a routine use of postoperative irradiation to the prostatic fossa produces an excellent (> 95%) incidence of local
tumor control. Management of patients with metastatic disease has undergone a considerable evolution with the development of modern hormonal management and treatment with
strontium-89 to control intractable bone
pain. Newer treatment methods such as
hyperthermia are currently being investigated. Major efforts are directed toward the reduction of short- and long-term treatment toxicity associated with surgery,
radiotherapy, and hormonal management, thus improving patient quality of life.