Controversies in the management of clinical T3 carcinoma of the prostate.

The therapy of all stages of prostate cancer remains controversial. Perhaps the management of T3 disease is most difficult to evaluate. By definition, T3 disease is: 1) outside the capsule of the prostate (with invasion of the pericapsular tissue, the apex, the bladder neck and/or the seminal vesicles); 2) mobile; and 3) localized to the pelvis. Pelvic fixation is described as T4 disease in the TNM system and will not be included in this review. Comparisons of various treatment methods are difficult to achieve due to the lack of knowledge regarding the natural history of this disease and the variations in staging methods. The number of patients diagnosed with clinical T3 cancer of the prostate in Canada and the US is unknown. It is estimated that approximately 145 000 cases of prostate cancer will be diagnosed in the two countries in 1994; furthermore, it is estimated that 12-15% or 15 000-18 000 of these cases will have T3 disease. The percentage of cases diagnosed as T3 is expected to drop with the increase use of methods of early detection.