Management of newly diagnosed metastatic carcinoma of the prostate

J. S. Elder, W. J. Catalona

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations

Abstract

Most patients with clinical stage D-0 prostatic cancer (persistently elevated acid phosphastase, normal bone scan, and normal lymph node evaluation) have occult distant metastases and should be treated conservatively at stage D-2 disease. Younger patients with stage D-0 disease may be candidates for staging pelvic lymphadenectomy to identify those having surgical stage D-1 disease (minimal lymph node metastases only), some of whom may benefit from radical prostatectomy. Alternatively, some younger patients with stage D-0 disease may experience long-term disease-free survival following whole-pelvic or extended-field external-beam radiation therapy. Most patients with surgical stage D-1 disease also will not benefit from curative treatments; therefore, they also should be treated generally as patients with stage D-2 disease. A small fraction (about 15 to 20 per cent) with minimal nodal disease may be cured by pelvic lymphadenectomy combined with radical prostatectomy or radiation therapy, but it is doubtful that the limited prospects for cure justify the morbidity and functional sacrifices associated with such therapy. Patients with stage D-2 disease (distant metastases) who are sexually potent may be treated with delayed endocrine therapy (preferably orchiectomy or alternatively 1 to 3 mg per day of diethylstilbestrol after breast irradiation). Immediate endocrine therapy is indicated for symptomatic patients, including those with bladder outlet or ureteral obstruction, and is also appropriate for asymptomatic patients who are sexually impotent.

Original languageEnglish (US)
Pages (from-to)283-295
Number of pages13
JournalUrologic Clinics of North America
Volume11
Issue number2
StatePublished - Jan 1 1984

ASJC Scopus subject areas

  • Urology

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