Current conflicts in the management of prostatic cancer.

In summary, 5-, 10-, and 15-year actuarial survival can be achieved in 81, 60, and 35% of patients with disease limited to the prostate and in 61, 36, and 18% of those with extracapsular extension. In various subgroups of patients with nodular disease who were selected by the same criteria applied in the selection for surgical resection, survival of 60% can be achieved. Conversely, local control may not be achieved following irradiation because of cell survival within the target volume. More sophisticated boost therapy using interstitial implants, high energy particles, radiosensitizers, and/or hyperthermia may improve local control and hence longer term survival. Local control may not be achieved following surgical resection because of transection of tumor at the surgical margin. Case selection for surgery might be improved by pre-operative transrectal ultrasonography or MRI examination. In situations in which pathologic examination demonstrates frank tumor transection, local control still may be achieved by prompt and judicious salvage by X-ray therapy.