THE CONSERVATIVE TREATMENT OF CARCINOMA OF THE PROSTATE

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Abstract
Conservative treatment comprises; (1) Radio‐therapy; (2) Surgical; and (3) Surgical with Radio‐therapy.The immediate results of X‐ray treatment are often excellent but the ultimate results are disappointing.In some cases X‐rays cause rapid increase of the growth and dissemination.The best results are obtained by the five‐field maximum method of Holfelder‐Reisner, giving a total depth dose of 150 to 200 per cent. on the prostate.The intensive split‐dose method of Levitt, now under trial, seems productive of better results. At present only 6 per cent. of cures can be claimed for modern methods of X‐ray therapy.The effects of radium are better, especially when applied in large doses to the rectal, vesical and urethral surfaces of the prostate. Before treatment is commenced a thorough clinical, biochemical and radiological examination must be made and a portion of the prostate should be removed by electro‐resection for microscopical examination.When renal function tests are below normal preliminary drainage of the bladder is necessary.About 70 mgs. of radium are used thus: 14 mgs. to the posterolateral surfaces, 50 mgs. to the vesical surface and 5 mgs. to the urethral surface.Though only a few cases have been treated in this way the cure rate has been 28 per cent. up to the present. The method is therefore worth an extended trial.Conservative surgery consists of suprapubic drainage, transplantation of the ureters and electro‐resection. Transplantation of the ureters into the large intestine is preferable to suprapubic drainage but can only be performed in carefully selected cases.Electro‐resection is the best palliative measure for the relief of obstruction by growth at the neck of the bladder: it is of no value when the obstruction is due to invasion of the prostatic urethra.It is probable that in the future electro‐resection, followed by some form of radio‐therapy, will be the method of choice.

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