The Treatment of Carcinoma of the Prostate Gland
Treatment of carcinoma of the prostate gland is still the subject of considerable controversy among urologists, and the mortality from this condition remains high. In 1927, statistics from the United States Census Bureau showed that of every 100,000 deaths reported among men, 5.6 were caused by malignant disease of the prostate gland. In 1934, carcinoma of the prostate caused 5.2 of every 100,000 deaths, according to the Bureau of Vital Statistics.
During the past ten years, various methods of treatment have been employed at the Cleveland Clinic in an attempt to evaluate the merits of each. Early recognition of the malignant process is essential and an understanding of the most frequent site of primary involvement and the usual mode of extension are of paramount importance in determining the efficacy of proposed treatment.
While the majority of carcinomas involving the prostate gland probably arise in the posterior lobe1, the initial lesion may originate in any portion of the gland or its accessory lobules. Geraghty2 demonstrated that in the majority of cases the primary site of the lesion is in the posterior lobe, i.e., the portion of the prostate lying between the base of the bladder and the fascia of Denonvillier. This is in accordance with the observations of R. A. Moore3 who studied fifty-two cases in which the lesion was sufficiently small that an accurate determination of the point of origin could be made. He found that 73.5 per cent arose in the posterior lobe, 8.8 per cent in the lateral. . .