Prostate cancer: emerging concepts. Part II.

OBJECTIVE

To review important topics related to prostate cancer that have arisen since this subject was last covered in Annals in 1993. The review consists of two parts. Part II describes neoadjuvant hormonal therapy, new local treatment options (including three-dimensional conformal radiation therapy, brachytherapy, and cryosurgery), antiandrogen therapy management of erectile dysfunction, funding and legislation for research, and areas for future research, especially in genetics investigations.

STUDY SELECTION

Randomized studies identified through a MEDLINE search (1992 to 1996); large, single-institutional conferences and consortiums; and studies presented at regional, national, and international symposia.

DATA SYNTHESIS

Qualitative and quantitative data are reported. Part II describes results of completed randomized trials that used neoadjuvant hormonal therapy. Studies have shown that nearly 50% more patients with cT2 disease will have pathologically confined (pT2) prostate cancer as a result of preoperative neoadjuvant hormonal therapy. Time to development of progressive disease and disease-free survival are improved in patients receiving neoadjuvant hormonal therapy before radiation therapy, but the long-term overall effects on survival of neoadjuvant therapy before surgery or radiation are unknown. Other methods for treating localized prostate cancer (three-dimensional conformal radiation therapy, brachytherapy, and cryotherapy) are gaining popularity, despite the lack of long-term efficacy results. Advances in the understanding of the optimal use of antiandrogens and managing treatment-induced erectile dysfunction continue to benefit patients with prostate cancer.

CONCLUSIONS

Prostate cancer is being detected with increasing frequency, and many patients are receiving such treatments as radical prostatectomy and radiation therapy. Although refinements in prostate-specific antigen (PSA)-based testing have contributed substantially to the increased rate of detection of prostate cancer, the incidence of disease was increasing dramatically even before PSA detection was possible. Despite earlier detection, the optimal therapy for the early form of the disease is still enigmatic. Further studies and longer follow-up of patients who participated in completed studies are needed to better define the outcomes and importance of prostate cancer therapies. More research is needed to help elucidate the reasons for the increased incidence of the disease; such efforts should help define strategies to ultimately prevent prostate cancer.