Prostatic adenocarcinoma. Considerations in management

Management of prostatic adenocarcinoma depends on the extent of disease as determined by staging procedures: digital rectal examination, histologic grading of the tissue specimen, and evaluation for dissemination of disease to bone and other distant sites. At this time there is no curative treatment for patients with widespread bone or visceral metastases. When the cancer is histologically confined to the gland and there are no lymph node or other metastases, total prostatectomy should be curative. Other therapeutic options with comparable success are external beam radiation and interstitial implantation of iodine 125 radioactive seeds. Pelvic lympho node dissection is appropriately used to assess the status of nodes prior to prostatectomy or implantation of radioactive seeds. Its therapeutic effectiveness has not yet been proved.