Cancer of the Prostate

Abstract

THE purpose of this paper is to evaluate the results of roentgen-ray and radium treatment for 152 cases of cancer of the prostate in the Radiological Department of the Philadelphia General Hospital. Since nearly every case required admission to the hospital when first seen, the study obviously resolves itself into an analysis of the palliative benefits of radiation for clinically advanced cases. The question is often raised: How much value is high voltage radiation for the late and advanced cases? Is it really worth while? With this object in view it seemed necessary: (a) to associate the relevant clinical data of age, duration of symptoms, diagnosis, extent of involvement, bone and gland metastasis as well as pathologic characters, and (b) to outline and discuss the technical procedures of radiation employed. For the study of the irradiation group, 82 cases were selected because they were known to have received an adequate dose of high voltage roentgen rays as compared with a clinically similar group of 70 cases receiving no irradiation. Every patient in this series died. The terminal stages of the disease in each instance were typical of cancer. The clinical factors were so variable that it was obviously difficult to evaluate end-results on the basis of statistics. Moreover, the beneficial effects are not always in conformity with statistical estimations, neither is the palpable extent of involvement a true record of the actual extent of the disease. The time incidence of the first symptom on hospital records does not always indicate the onset of the disease by any means. In many instances roentgen-ray studies are negative for bone metastasis, yet it is possible for metastasis to exist and to be of such slight involvement that it is not readily subject to x-ray demonstration. There were several instances in this series in which cases presented lumbar and sacro-iliac pains of sufficient intensity to justify the inference of metastasis, yet this evidence was not obtained to a definite and indisputable degree for as long as from two to four months in five cases in this group. The advanced stages of the material in these 152 cases is indicated by the fact that 82 per cent were admitted to the hospital when first seen, only 18 per cent being at first treated as ambulatory cases. On the other hand, the cases with high or medium degrees of malignancy are probably representative of the average case from the standpoint of duration of symptoms when medical advice is first obtained, because the average duration of symptoms at the first consultation was from six to twelve months. The only cases in this series that are probably not representative of what might be regarded as clinically “early,” are the group of so-called low grade malignancies.