Prostate Cancer: More Questions Than Answers?

  • W. B. Peeling
  • K. Griffiths


A great deal of information has been gathered together during the past 50 years about the pathology of prostate cancer, its endocrinology, cell biology and particularly its clinical features and behaviour. Despite this, there is uncertainty about its causes and natural history, and as there is still considerable debate about methods of treatment it is probably not surprising that mortality from the disease remains much as it was 30 to 40 years ago. It would appear, therefore, that there has been limited forward progress in the clinical management of this disease so what should we be examining in the last decade of the twentieth century, to find some answers, particularly to reduce mortality?


Prostate Specific Antigen Radical Prostatectomy Prostate Volume Digital Rectal Examination Advanced Prostate Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Arduino LJ et al. (Veterans Administration Co-operative Urological Research Group) (1967) Carcinoma of the prostate: treatment comparisons. J Urol 98:516–522Google Scholar
  2. Babaian RJ, Miyashita H, Evans RB, Ramirez EJ (1992) The distribution of prostate specific antigen in men without clinical or pathological evidence of prostate cancer: relationship to. gland volume and age. J Urol 147: 837–840PubMedGoogle Scholar
  3. Beland G, Elhilali M, Fradet Y et al. (1991) Total androgen ablation: Canadian experience. Urol Clin North Am 18: 75–82PubMedGoogle Scholar
  4. Bertermann H (1990) Ultrasound-guided prostatic biopsy. In: Peeling WB (ed.) The role of imaging in prostatic cancer. Medical Group (UK) Limited, Abingdon, Oxon. pp 51–57Google Scholar
  5. Blackard CE (1975) The Veterans Administrative Co-operative Urological Research Group studies of carcinoma of the prostate: a review. Cancer Chemother Rep 59: 225–227PubMedGoogle Scholar
  6. Blandy JP (1991) The rationale for screening for cancer of the prostate. The arguments against. Urol Top 4: 40–41Google Scholar
  7. Boring CC, Squires TS, Tong T (1991) Cancer statistics, 1991. Cancer 41: 19–36Google Scholar
  8. Brawer MK, Chetner MP, Beatie J, Büchner DM, Vessella RL, Lange PH (1992) Screening for prostatic cancer with prostate specific antigen. J Urol 147: 841–845PubMedGoogle Scholar
  9. Bruchovsky N, Rennie PS, Coldman AJ, Goldenberg SL, To M, Lawson D (1990) The effects of androgen withdrawal on the stem cell composition of the Shionogi carcinoma; Cancer Res 50: 2275–2282PubMedGoogle Scholar
  10. Burge PD, Harper ME, Hartog M, Gingell JC (1976) Subcapsular orchidectomy - an effective operation? Proc R Soc Med 69: 663–664PubMedGoogle Scholar
  11. Byar DP (1973) The Veterans Administrative Cooperative Urological Research Group studies of cancer of the prostate. Cancer 32: 1126–1130PubMedCrossRefGoogle Scholar
  12. Byar DP (1977) VACURG studies on prostatic cancer and its treatment. In: Tannenbaum M (ed.) Urologie pathology: the prostate. Lea and Febiger, Philadelphia, pp 241–267Google Scholar
  13. Byar DP, Corle DK (1988) Hormone therapy for prostate cancer: results of the Veterans Administrative Co-operative Urological Research Group studies. In: Consensus Development Conference in the management of clinically localized prostate cancer. NCI Monogr 7: 165–170Google Scholar
  14. Cantrell BB, de Klerk DP, Eggleston JC, Botnott JK, Walsh PC (1981) Pathological factors that influence prognosis in stage A prostate cancer. The influence of extent versus grade. J Urol 125: 516–520Google Scholar
  15. Carter HB, Coffey DS (1988) Prostate cancer: the magnitude of the problem in the United States. In: Coffey DS, Resnick MI, Dorr FA et al. (eds) A multidisciplinary analysis of controversies in the management of prostatic cancer. Plenum Press, New York, pp 1–7CrossRefGoogle Scholar
  16. Cassileth BR, Soloway MS, Vogelzang NJ et al. (1989) Patients’ choice of treatment in stage D prostate cancer. Urology 33 (suppl): 57–62PubMedCrossRefGoogle Scholar
  17. Catalona WJ, Smith DS, Ratliff TL et al. (1991) Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 324: 1156–1161PubMedCrossRefGoogle Scholar
  18. Chadwick DJ, Gillatt DA, Gingell JC (1991a) Medical or surgical orchidectomy: the patients’ choice. Br Med J 302: 572CrossRefGoogle Scholar
  19. Chadwick DJ, Kemple T, Astley JP et al. (1991b) Pilot study of screening for prostate cancer in general practice. Lancet 338: 613–615CrossRefGoogle Scholar
  20. Chisholm GD (1981) Carcinoma of the prostate: perspectives and prospects. In: Duncan W (ed) Prostate cancer - Recent results in cancer research. Volume 78. Springer-Verlag, Heidelberg, pp 173–184Google Scholar
  21. Chodak GW, Schoenberg HW (1989) Progress and problems in screening for carcinoma of the prostate. World J Surg 13: 60–64PubMedCrossRefGoogle Scholar
  22. Chodak GW, Keller P, Schoenberg HW (1989) Assessment of screening for prostate cancer using the digital rectal examination. J Urol 141: 1136–1138PubMedGoogle Scholar
  23. Clements R, Griffiths GJ, Peeling WB, Roberts EE, Evans KT (1988) How accurate is the index finger? A comparison of digital and ultrasound examination of the prostatic nodule. Clin Radiol 39: 87–89PubMedCrossRefGoogle Scholar
  24. Clements R, Penney MD, Etherington RJ, Griffiths GJ, Hughes H, Peeling WB (1992) Volume of normal prostate, of prostate cancer and benign prostatic hyperplasia: are correlations with prostate specific antigen clinically useful? Prostate (Suppl 4 ): 51–57CrossRefGoogle Scholar
  25. Crawford ED, Nabors WL (1991) Total androgen ablation: American experience. Urol Clin North Am 18: 55–63PubMedGoogle Scholar
  26. Crawford ED, Eisenberger MA, McLeod DG et al. (1989) A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. N Engl J Med 321: 419–424PubMedCrossRefGoogle Scholar
  27. Dahnert WF, Hamper UM, Eggleston JC, Walsh PC, Sanders RC (1986) Prostatic evaluation by transrectal sonography with histopathologic correlation: the echopenic appearance of early carcinoma. Radiology 158: 97–102PubMedGoogle Scholar
  28. Denis L, Smith P, Carneiro de Moura JL et al. (1991) Total androgen ablation: European experience. Urol Clin North Am 18: 65–73PubMedGoogle Scholar
  29. Dijkman GA, Fernandez del Moral P, Plasman JWM et al. (1990) A new longer-acting LH RH analog depot: preliminary results of a Dutch open phase II clinical study on a 10.8 mg Zoladex 3-monthly depot. Eur Urol 18 (suppl 3): 22–25PubMedGoogle Scholar
  30. Drago JR, Badalament RA (1990) Prostate cancer: early detection and screening. In: Resnick MI (ed) Prostatic ultrasonography. B C Decker Inc, Philadelphia, pp 103–112Google Scholar
  31. Dyke CH, Toi A, Sweet JM (1990) Value of random ultrasound-guided transrectal prostate biopsy. Radiology 176: 345–349PubMedGoogle Scholar
  32. Epstein JI, Steinberg GD (1990) The significance of low-grade prostate cancer on needle biopsy. Cancer 66: 1927–1932PubMedCrossRefGoogle Scholar
  33. Epstein JI, Pauli G, Eggleston JC, Walsh PC (1986) Prognosis of untreated stage Al prostatic carcinoma: a study of 94 cases with extended follow-up. J Urol 136: 837–839PubMedGoogle Scholar
  34. Esposti PL, Franzen S (1980) Transrectal aspiration biopsy of the prostate. A re-evaluation of the method in the diagnosis of prostatic carcinoma. Scand J Urol Nephrol (Suppl 55 ): 49–52Google Scholar
  35. Fornage BD (1988) Ultrasound guided biopsy. In: Fornage BD (ed) Ultrasound of the prostate. Wiley, Chichester, pp 239–269Google Scholar
  36. Franks LM (1954) Latent carcinoma of the prostate. J Pathol Bacteriol 68: 603–616PubMedCrossRefGoogle Scholar
  37. Gerber GS, Chodak GW (1990) Digital rectal examination in the early detection of prostate cancer. Urol Clin North Am 17: 739–744PubMedGoogle Scholar
  38. Haapiainen R, Rannikko S, Ruutu M et al. (1991) Orchiectomy versus oestrogen in the treatment of advanced prostatic cancer. Br J Urol 67: 184–187PubMedCrossRefGoogle Scholar
  39. Hanash KA, Utz DC, Cook EN, Taylor WF, Titus JL (1972) Carcinoma of the prostate–a 15 year follow-up. J Urol 107: 450–453PubMedGoogle Scholar
  40. Handley R, Carr TW, Travis D, Powell PH, Hall RR (1988) Deferred treatment for prostate cancer. Br J Urol 62: 249–253PubMedCrossRefGoogle Scholar
  41. Hanks GE (1989) External beam radiation therapy for prostate cancer clinically confined to the gland. Urology 33 (suppl): 21–26PubMedCrossRefGoogle Scholar
  42. Harper ME, Glynne-Jones E, Goddard L et al. (1992a) Relationship of proliferating cell nuclear antigen ( PCNA) in prostatic carcinomas to various clinical parameters. Prostate 20: 243–253CrossRefGoogle Scholar
  43. Harper ME, Goddard L, Wilson DW et al. (1992b) Pathological and clinical associations of Ki-67 defined growth fractions in human prostatic carcinoma. Prostate 20: 371–376CrossRefGoogle Scholar
  44. Hillyard JW (1987) Bacteraemia following perineal prostatic biopsy. Br J Urol 60: 252–254PubMedCrossRefGoogle Scholar
  45. Hinman H Jr (1991) Screening for prostatic carcinoma. J Urol 145: 126–130PubMedGoogle Scholar
  46. Hodge KK, McNeal JE, Stamey TA (1989) Ultrasound guided transrectal core biopsies of the palpably abnormal prostate. J Urol 142: 66–70PubMedGoogle Scholar
  47. Horm JW, Asire AJ, Young JL, Pollack ES (1984) Cancer incidence and mortality in the United States: 1973–81. NIH Publication No 85–1837, National Cancer Institute, November 1984Google Scholar
  48. Huggins C, Hodges CV (1941) Studies on prostate cancer I: The effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. Cancer Res 1: 293–297Google Scholar
  49. Isaacs JT (1984) The timing of androgen ablation therapy and/or chemotherapy in the treatment of prostatic cancer. Prostate 5: 1–17PubMedCrossRefGoogle Scholar
  50. Iversen P, Suciu S, Sylvester R, Christensen I, Denis L (1990) Zoladex and flutamide versus orchiectomy in the treatment of advanced prostatic cancer. Cancer 66: 1067–1073PubMedGoogle Scholar
  51. Jewett HJ (1975) The present status of radical prostatectomy for stages A & B prostatic cancer. Urol Clin North Am 2: 105–124PubMedGoogle Scholar
  52. Jonsson G, Olsson AM, Luttrop W, Cekan Z, Purvis K, Diczfalusy E (1975) Treatment of prostatic carcinoma with various types of oestrogen derivatives. Vitam Horm 33: 351–376PubMedCrossRefGoogle Scholar
  53. Kaplan ID, Prestidge BR, Bagshaw MA, Cox RS (1992) The importance of local control in the treatment of prostatic cancer. J Urol 147: 917–921PubMedGoogle Scholar
  54. Kaufman JJ, Schultz JI (1962) Needle biopsy of the prostate: a re-evaluation. J Urol 87: 164–168PubMedGoogle Scholar
  55. Kirk D (1987) Trials & Tribulations in prostatic cancer. Br J Urol 59: 375–379PubMedCrossRefGoogle Scholar
  56. Klotz LH, Herr HW, Morse MJ, Whitmore WF Jr (1986) Intermittent endocrine therapy for advanced prostate cancer. Cancer 58: 2546–2550PubMedCrossRefGoogle Scholar
  57. Kramolovsky EV (1988) The value of testosterone deprivation in stage D1 carcinoma of the prostate. J Urol 139: 1242–1244Google Scholar
  58. Labrie F, Dupont A, Belanger A et al. (1983) New approaches in the treatment of prostate cancer: complete instead of partial withdrawal of androgens. Prostate 4: 579–594PubMedCrossRefGoogle Scholar
  59. Labrie F, Veilleux R, Fournier A (1988) Low androgen levels induce the development of androgen-hypersensitive cell clones in Shionogi mouse mammary carcinoma cells in culture. J Natl Cancer Inst 80: 1138–1147PubMedCrossRefGoogle Scholar
  60. Lardennois B, Vazeux H, Visseaux-Coletto B, Adnet JJ, Ploton D (1990) The value of nucleolar organizer regions (NORs) with the histo-prognosis determination of prostatic cancer. Eur Urol 18 (suppl 1): 68Google Scholar
  61. Lee F, Littrup PJ, McLeary RD et al. (1987) Needle aspiration and core biopsy of prostate cancer: comparative evaluation with biplanar transrectal US guidance. Radiology 163: 515–520PubMedGoogle Scholar
  62. Lee F, Littrup PJ, Torp-Pedersen ST et al. (1988) Prostate cancer: comparison of transrectal ultrasound and digital rectal examination for screening. Radiology 168: 389–394PubMedGoogle Scholar
  63. Lee F, Torp-Pedersen ST, Littrup PJ et al. (1989) Hypoechoic lesions of the prostate: clinical relevance of tumor size, digital rectal examination and prostate-specific antigen. Radiology 170: 29–32PubMedGoogle Scholar
  64. Lepor H, Ross A, Walsh PC (1982) The influence of hormonal therapy on survival of men with advanced prostatic cancer. J Urol 128: 335–340PubMedGoogle Scholar
  65. Littrup PJ, Kane RA, Williams CR et al. (1991) Determination of prostate volume with transrectal ultrasound for cancer screening. Part I: comparison with prostate specific antigen assays. Radiology 178: 537–542PubMedGoogle Scholar
  66. Love RR, Camilli AE (1981) The value of screening. Cancer 48: 489–494PubMedCrossRefGoogle Scholar
  67. Lowe BA, Listrom MB (1988) Incidental carcinoma of the prostate: an analysis of the predictors of progression. J Urol 140: 1340–1344PubMedGoogle Scholar
  68. Lunglmayr G, Girsch E (1987) Patient choice in the treatment of advanced prostate cancer. In: Chisholm GD (ed) Zoladex, a new treatment for prostatic cancer. Alden Press, Oxford(Royal Society of Medicine Services International Congress & Symposium Series, No. 125 ) pp 47–51Google Scholar
  69. McClinton S, Moffat LEF, Ludbrook A (1989) The cost of bilateral orchidectomy as a treatment for prostatic carcinoma. Br J Urol 63: 309–312PubMedCrossRefGoogle Scholar
  70. McNeal JE, Bostwick DG, Kindrachuk RA, Redwine EA, Freiha FS, Stamey TA (1986) Patterns of progression in prostate cancer. Lancet i: 60–63Google Scholar
  71. Middleton RG, Larsen RH (1990) Radical prostatectomy for Stage B disease. Urol Clin North Am 17: 779–785PubMedGoogle Scholar
  72. Mitchell CB, Ring K, Giella J (1990) Flow cytometry in carcinoma of the prostate. Urol Clin North Am 17: 885–891Google Scholar
  73. Nesbit RM, Baum WC (1950) Endocrine control of prostatic carcinoma: clinical and statistical survey of 1818 cases. JAMA 143: 1317–1320Google Scholar
  74. Noble RL (1977) Hormonal control of growth and progression in tumors of Nb rats and a theory of action. Cancer Res 37: 82–94PubMedGoogle Scholar
  75. Oesterling JE, Epstein JI, Walsh PC (1986) The viability of adrenal androgens to stimulate the adult human prostate: an autopsy evaluation of men with gonadotrophic hypogonadism and panhypopituitarism. J Urol 136: 1030–1034PubMedGoogle Scholar
  76. Office of Population Censuses and Surveys (1976) In: Series DH2 No.1. Cancer statistics: mortality in England and Wales, 1974. HMSO, LondonGoogle Scholar
  77. Office of Population Censuses and Surveys (1991a) In: Series MB1 No. 19. Cancer statistics: registrations: cases of diagnosed cancer registered in England & Wales, 1986. HMSO, LondonGoogle Scholar
  78. Office of Population Censuses and Surveys (1991b) In: Series DH2 No. 17. Cancer statistics: mortality in England and Wales, 1990. HMSO, LondonGoogle Scholar
  79. Office of Population Censuses and Surveys (1992) England and Wales: Population Estimate Unit. HMSO, LondonGoogle Scholar
  80. Optenberg SA, Thompson IM (1990) Economics of screening for carcinoma of the prostate. Urol Clin North Am 17: 719–737PubMedGoogle Scholar
  81. Paulson DF, Lin GH, Hinshaw W, Stephani S and the Uro-Oncology Research Group (1982) Radical surgery versus radiotherapy for adenocarcinoma of the prostate. J Urol 128: 502–504Google Scholar
  82. Peeling WB (1987) A phase III trial comparing ICI 118630 (Zoladex) with orchidectomy in the management of advanced prostatic cancer. In: Chisholm GD (ed) Zoladex, a new treatment for prostatic cancer. Alden press, Oxford, ( Royal Society of Medicine Services International Congress and Symposium Series, No 125 ) pp 27–44Google Scholar
  83. Peeling WB (1991) Are stilboestrol and orchidectomy outmoded? In: Alderson AR, Oliver RTD, Hanham IWF, Bloom HJG (eds) Urological oncology. Dilemmas and developments. Wiley, Chichester, pp 203–210Google Scholar
  84. Peeling WB, Griffiths GJ (1984) Imaging of the prostate by ultrasound J Urol 132: 217–224PubMedGoogle Scholar
  85. Reece D (1991) Breast cancer screening is doing well. Br Med J 302:311Google Scholar
  86. Rifkin MD, Choi H (1988) Implications of small, peripheral hypoechoic lesions in endorectal ultrasound of the prostate. Radiology 166: 619–622Google Scholar
  87. Salo JO, Rannikko S, Makinen J, Lehtonen T (1987) Echogenic structure of prostatic cancerimaged on radical prostatectomy specimens. Prostate 10: 1–9PubMedCrossRefGoogle Scholar
  88. Shearer RJ, Hendry WF, Sommerville IF, Fergusson JD (1973) Plasma testosterone: an accurate monitor of hormone treatment in prostatic cancer. Br J Urol 45: 668–677PubMedCrossRefGoogle Scholar
  89. Smith JA Jr, Seaman JP, Gleidman JB, Middleton RG (1983) Pelvic lymph node metastasis from prostatic cancer: influence of tumor grade and stage in 452 consecutive patients. J Urol 130: 290–292PubMedGoogle Scholar
  90. Smith PH (1990) The case for no initial treatment of localized prostate cancer. Urol Clin North Am 17: 827–834PubMedGoogle Scholar
  91. Stamey TA (1982) Cancer of the prostate. An analysis of some important contributions and dilemmas. Monogr Urol 3: 67–94Google Scholar
  92. Stamey TA, Yang N, Hay AR, McNeal JE, Freiha FS, Redwine E (1987) Prostate specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med 317: 909–916PubMedCrossRefGoogle Scholar
  93. Thompson IM, Ernst JJ, Gangai MP, Spence CR (1984) Adenocarcinoma of the prostate: results of routine urological screening. J Urol 132: 690–692PubMedGoogle Scholar
  94. Torp-Pedersen S, Lee F, Littrup PJ et al. (1989) Transrectal biopsy of the prostate guided with transrectal ultrasound: longitudinal and planar scanning. Radiology 170: 23–27PubMedGoogle Scholar
  95. Tyrrell CJ, Altwein JE, Klippel F et al. (1991) A multicenter randomized trial comparing the luteinizing hormone-releasing hormone analogue goserelin acetate alone and with flutamide in the treatment of advanced prostate cancer. J Urol 146: 1321–1326PubMedGoogle Scholar
  96. Union Internationale Contre le Cancer (1978) In: Harmer MH (ed) TNM Classification of malignant tumours, 3rd edn. G. de Buren SA, Geneva, pp 118–121Google Scholar
  97. Union Internationale Contre le Cancer (1987) In: Hermanek P, Sobin LH (eds) TNM classification of malignant tumours, 4th edn. Springer-Verlag, Berlin, pp. 121–126Google Scholar
  98. Venner PM, Klotz G, Klotz LH et al. (1988) Megestrol acetate plus minidose diethylstilbestrol in the treatment of carcinoma of the prostate. Semin Oncol 15 (suppl l): 62–67PubMedGoogle Scholar
  99. Vikho P, Kontturi M, Lukkarinen O, Ervasti J, Vikho R (1985) Screening for carcinoma of the prostate. Rectal examination, and enzymatic and radio-immunologic measurements of serum acid phosphatase compared. Cancer 56: 173–177CrossRefGoogle Scholar
  100. Walker KJ, Turkes AO, Turkes A et al. (1984) Treatment of patients with advanced cancer of the prostate using a slow release (depot) formulation of the LH RH agonist ICI 118630 (Zoladex). J Endocrinol 103: R1–R4PubMedCrossRefGoogle Scholar
  101. Walsh PC (1986) Radical retropubic prostatectomy. In: Walsh PC, Gittes RF, Perlmutter AD, Stamey TA (eds) Campbell’s urology, Vol 2, 5th edn. W B Saunders Co, Philadelphia, pp 2772–2775Google Scholar
  102. Walsh PC (1992) Why make an early diagnosis of prostate cancer. J Urol 147: 853–854PubMedGoogle Scholar
  103. Waymont B, Lynch TH, Dunn JA et al. (1992) Phase III randomised study of Zoladex versus stilboestrol in the treatment of advanced prostate cancer. Br J Urol 69: 614–620PubMedCrossRefGoogle Scholar
  104. Whitmore WF Jr (1956) Hormone therapy in prostatic cancer. Am J Med 21: 697–713PubMedCrossRefGoogle Scholar
  105. Wilson JMG, Jungner G (1968) Principles and practice of screening for disease. In: Public Health Paper No 4, World Health Organization, Geneva, pp 26–27Google Scholar

Copyright information

© Springer-Verlag London Limited 1994

Authors and Affiliations

  • W. B. Peeling
  • K. Griffiths

There are no affiliations available

Personalised recommendations