Therapeutic options in the management of incidental carcinoma of the prostate.

Abstract

Incidental carcinoma of the prostate is a protean disease with a natural course which may be indolent or aggressive, with prognosis correlated with histologic grade and extent of disease. Treatment of this pathologic entity has varied over time and has been governed by institutional policy rather than randomized comparison of therapies. This report reviews the literature on incidental prostate cancer focusing on outcomes of patients as related to different therapeutic maneuvers. Observation alone with careful follow-up is appropriate therapy only for those patients with well differentiated disease of limited extent. Patients with diffuse or less differentiated disease required definitive therapy to prevent symptomatic progression. Hormonal manipulation alone has not been demonstrated to be of benefit. Radioactive implants have yielded poor disease-free survival. Radical prostatectomy by an experienced surgeon for patients with adequate health to tolerate the procedure has been associated with acceptable morbidity and excellent local control and survival. Radiation therapy has yielded similar excellent local control and survival and appears to be appropriate for a broader range of patients regardless of health or age.