Limits and possibilities of surgical treatment of locally advanced prostatic carcinoma

Prostatic carcinoma is the second most diagnosed malignant tumor in the Netherlands, only carcinoma of the lung is more frequent. In 1991 4343 men were diagnosed with prostate cancer, making up 14.1% of all diagnosed malignant tumors. In the age-group 60-74 years the incidence was second after pulmonary carcinoma, and in the age-group >75 years it is the most frequently diagnosed malignancy. In 1991 2108 patients died because of prostate cancer. The mortality/incidence ratio is 0,49; which means that about 50% of the patients will die because of their prostatic malignancy. The incidence of prostatic cancer in developed countries is rising. Lu-Yao reported an increase in the incidence-rates of prostatic cancer in the United States of America of6.4% per year between 1983 and 1989'. This increase appeared to be due to the detection of early-stage disease, but there was no increase in the incidence-rate of metastatic cancer. There was no increase in mortality rates during this study-period. In the Netherlands 3% of all mortality among men was due to prostate cancer (1989) 3. In 1994 van der Gulden reported on the trends in mortality-rates for patients with prostate cancer in the Netherlands'. The age-adjusted mortality-rates rose between 1950 and 1989 with an average increase of 1 % per year. A continuous increase of mortality from prostate cancer was found in consecutive birth-cohorts (defined by combining age and calender-time periods on the basis of their central year of birth). There was a steep rise in the mortality from prostate cancer with age; for the age-category 55-59 years the prostate cancer mortality-rate was 11.2 per 100.000 man-years, but for the category >85 years this was 921.8. This rise in the incidence and mortality of prostate cancer points out that this disease will become more and more important in the years to come. Since more cancers tend to be localized, the role of radical prostatectomy in the treatment of prostatic carcinoma will become even more important than it is today.