Prostate cancer. Promising advances that may alter survival rates.

Recent advances in the diagnosis and treatment of patients with prostate cancer have altered clinical management of the disease. Although direct rectal examination remains the standard clinical tool for staging prostate cancer, transrectal ultrasound appears to be about twice as sensitive for detection. Prostate-specific antigen (PSA) has replaced prostate-specific acid phosphatase as a serum tumor marker for prostate cancer. When used in conjunction with measurement of prostate volume by transrectal ultrasound, PSA values may identify patients at increased risk for occult cancer. Use of transrectal ultrasound and PSA values has also improved the accuracy of clinical staging. Modifications in the technique of radical prostatectomy have minimized the morbidity associated with this procedure, making it a more attractive therapeutic option in patients with localized prostate cancer. In patients with metastatic disease, total androgen blockade is an option that appears superior to standard hormonal therapy.