title: Nonsurgical management of patients with stage D1 adenocarcinoma of prostate: risks vs benefits.
abstract: Within two years of diagnosis, 50 per cent of patients with Stage D1 prostatic adenocarcinoma will have clinically overt metastatic disease. Any purely local therapy (e.g., radical prostatectomy) appears to offer little in terms of the risk:benefit ratio. However, some form of local therapy is appropriate, since the untreated primary may continue to act as a source of metastases. 125I implantation with concomitant systemic therapy is an excellent therapeutic option for the majority of these patients. If one accepts the premise that local therapy is of limited value in metastatic disease, systemic treatment at the time of initial diagnosis should be considered. According to the data presented by the Mayo Clinic Group, immediate orchiectomy may be the best form of therapy. An alternative to orchiectomy is estrogen therapy or the more recently introduced GnRH analogues. Finally, the issue of identifiable tumor characteristics is addressed. The course of treatment may well be influenced by the identification of biologically aggressive tumors, using indicators such as elevated acid phosphatase. It is still undetermined whether stereology or flow cytometric analysis will further identify slower growing tumors from the more aggressive ones.
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*