Management of locally advanced prostatic carcinoma by surgery: does screening for prostatic cancer make sense?

Summary

Screening for prostatic cancer would be of advantage only if removal of the small volume localized malignancy provided enhanced disease control over that seen in patients with larger volume disease. The data which is reported herein would indicate that rarely is a focal disease truly focal and that these patients may have an increased probability of subsequent disease when the focal disease is treated conservatively. A 2 disease should be staged and treated to determine if it is organ-confined and, if so, be managed in a manner similar to clinical stage B lesions which are apparently organ-confined after appropriate staging. The data presented herein would indicate that, following radical surgery, disease which is specimen confined experiences enhanced control over that which is specimen confined, with margin-positive patients having the worse ultimate prognosis. The data strongly suggests that detection of disease while it is still organ-confined provides an increased probability of control should surgery be selected for treatment. Therefore, when considering the use of surgery for control of disease, any method which would detect the disease while it is still small volume and organ-confined would provide an enhanced probability of achieving a disease-free patient after application of treatment.