CA: A Cancer Journal for Clinicians, Vol 27, 308-314, Copyright
© 1977 by American Cancer Society
The Early Diagnosis and Radical Cure of Carcinoma of the Prostate
Hugh H. Young M.D.
The following conclusions may be drawn from this study. Carcinoma of the prostate is more frequent than is usually supposed—occurring in about 10 percent of the cases of prostatic enlargement, as shown also by Albarran. It may begin as an isolated nodule in an otherwise benign hypertrophy or a prostatic enlargement which has for many years furnished the symptoms, and signs of benign hypertrophy may suddenly become evidently malignant.
Marked induration, if only an intralobar nodule in one or both lobes of the prostate in men past 50 years of age should be viewed with suspicion, especially if the cystoscope shows little intravesicular prostatic outgrowth, and pain and tenderness are present.
The posterior surface of the prostate should be exposed as for an ordinary prostatectomy, and if the operator is unable to make a positive diagnosis of malignancy, longitudinal incisions should be made on each side of the urethra (as in prostatectomy) and a piece of tissue excised for frozen sections, which can be prepared in about six minutes and examined by the operator at once. If the disease is malignant the incisions may be cauterized and closed and the radical operation performed.
Cancer of the prostate remains for a long time within the confines of the lobes, the urethra, bladder and especially the posterior capsule of the prostate resting inviolate for a considerable period. Extraprostatic invasion nearly always occurs first along the ejaculatory ducts into the space immediately above the prostate between the seminal vesicles and the bladder and beneath the fascia of Denonvilliers. Thence the disease gradually invades the inferior surface of the trigone and the lymphatics leading toward the lateral walls of the pelvis, but involvement of the pelvic glands occurs late and often the disease metastasizes into the osseous system without first invading the glands.
Cure can be expected only by radical measures and the routine removal of the seminal vesicles, vasa deferentia and most of the vesical trigone with the entire prostate as carried out in four cases by the writer is shown to be necessary by the 40 cases, including eight autopsies and 10 operations, reported above.
The four cases in which the radical operation was done demonstrated its simplicity, effectiveness and the remarkably satisfactory functional results furnished.
