One of the most common forms of cancer in men, prostatic cancer, strikes about 35,000 men in the United States each year and kills 17,000, but it affects relatively few men under 35 years of age.
Cancer of the prostate accounts for 11 percent of cancers occurring among men in the United States; it affects relatively few men under 36 years of age.
Frequent, thorough rectal examinations are helpful in detecting this disease early. However, in a recent study of 2,000 patients with prostatic cancer, only 13 percent were discovered in a potentially curable stage.
The prostate is a chestnut-sized gland that is part of the male genital system. If the cancer of this organ is limited to a small nodule or hard area in the gland itself, surgical removal is usually successful. Among elderly men, prostatic cancer is sometimes present in a latent, microscopic stage and may safely go untreated, since it progresses very slowly.
When cancer extends beyond the prostate, alteration of the production of male hormones is the usual treatment. This is carried out either through surgical removal of the testes (orchiectomy) or administration of female sex hormones (estrogens). However, the desirability of hormonal treatment is undergoing re-evaluation since publication in 1967 of the results of a study of more than 2,000 patients at 14 Veterans' Administration hospitals. A substantially higher overall mortality rate was found in estrogen-treated patients than in patients assigned to treatment not including estrogen. Although the patients receiving estrogen showed a modest decrease in mortality rate from prostatic cancer, this decrease was outweighed by a substantial increase in deaths from heart disease and cerebrovascular accidents.The study suggested that therapy by estrogen or orchiectomy should be withheld, considering the potential risks, until the symptoms become severe enough to require relief.
In localized cancer of the prostate, radiotherapy combined with surgery is often helpful. In a study evaluating this type of treatment, 430 patients were injected in and around the prostate with radioactive gold, Au 198, in a colloidal suspension, and were then treated surgically. The 5-year survival rate of 47 percent for this group contrasted favorably with a survival rate at 5 years of 33 percent among 1,193 patients in the study who received surgical treatment only.
Radiotherapy, particularly supervoltage irradiation, may have value in the palliation of bone metastases. X-irradiation of skeletal metastases, or systemic irradiation with radioactive phosphorus, provides relief of bone pain in a large percentage of patients. A study has been reported recently in which treatment of a small group of patients with inoperable but localized cancer of the prostate with supervoltage radiation therapy produced long-term remissions of 5 years or more and eliminated symptoms of the disease.