An aggressive approach to prostatic cancer.

During the last 47 years an aggressive approach to the treatment of prostatic malignancies has been maintained at the Duke University Medical Center. Radical prostatectomy, usually by the perineal route and, more recently, by the retropubic technique in conjunction with pelvic lymphadenectomy, has been vigorously applied in patients with diffuse stages A, B and even C diseases. A 5-year survival rate of 80 per cent has been documented. Hormonal therapy has been equally vigorous, most often embracing orchietomy at the time of diagnosis with immediate initiation of estrogen therapy. Patients so treated exhibited a 5-year survival rate of 49 per cent, far greater than the average survival rates usually quoted. Radiation therapy had been used primarily in conjunction with other treatment measures, and multiple drug chemotherapy is now being used in patients who demonstrate disseminated and progressive disease, refractory to other measures previously instituted. By maintaining flexible combinations of all modalities of therapy our overall 5-year survival rate of 50 per cent has been achieved with all patients exhibiting all stages and classifications of prostatic carcinoma.