CURRENT QUESTIONS AND CONTROVERSIES ABOUT PROSTATE-CANCER MANAGEMENT

Questions and controversies surround the treatment of prostatic adenocarcinoma at all the stages of the disease. Inpatients with subclinical tumors identified in transurethral resection or prostatectomy specimens, the wait-and-see approach that is usually advocated should sometimes be replaced by curative treatment in young patients or subjects with high-grade tumors. Intraprostatic tumors are amenable to curative treatment. Radical prostatectomy may not be appropriate in patients with positive lymph nodes. When the histological study demonstrates positive margins, the need for, and ideal timing of, adjunctive treatment remains unsettled. In locally advanced prostate cancer, various combinations of available treatment modalities have been advocated. The most controversial issue is whether or not neoadjuvant hormone therapy is indicated prior to radical prostatectomy. External beam radiation therapy remains useful at this stage. The treatment of metastatic disease is hormone therapy. The need for complete androgen suppression has not been demonstrated. No effective treatment alternatives are available for patients who develop escape phenomenon. These patients should receive palliative treatment aimed at improving quality of life.