Surgery

Abstract

The surgeon’s first responsibility in the management of carcinoma of the prostate is to detect the presence of the disease. Malignancy may be suspected on digital palpation of the prostate, and then microscopic evidence must be provided by biopsy. Alternatively, the carcinoma may be discovered incidentally in tissue removed for the correction of bladder-neck obstruction. Whichever way the tumour is diagnosed, it is the surgeon’s next responsibility to define the stage of the disease — the local extent of the primary growth, whether it is necessary to study the pelvic lymph nodes, and whether there is any evidence of distant metastases. More difficult, an attempt should be made to gauge the malignant potential of the tumour in a particular patient. Once this information is assembled, the surgeon has to choose the best therapeutic approach. He can try to cut out the cancer: but few of us believe that this is a valid first-line approach, especially with prostate carcinoma. If the patient is fortunate he may be entered into a well-thought-out, carefully constructed prospective trial. This will ensure that his disease is adequately staged, and management will be by one of two or more options which are appropriate for his disease at his age. In may be pointed out that there is evidence that patients in trials do better than those who are not (Lennox et al. 1979). The surgeon’s contribution to the endocrine management of the patient may include orchidectomy and, later in the course of the disease, adrenalectomy or pituitary ablation.