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BMJ 1997; 315 doi: (Published 06 December 1997) Cite this as: BMJ 1997;315:1549
  1. Peter Whelan, is a consultant urologist in
  1. Leeds

    In 1989 carcinoma of the prostate was a decidedly provincial, indeed, almost homely type of disease. It had been known for more than 30 years to have a high latent prevalence, varying between 1:3 and 1:2 of all men, depending on their age, but it seemed to have a relatively small, clinical incidence. The diagnosis was made in most patients during their eighth decade, usually by the pathologists, following a prostatectomy for relief of obstructive urinary symptoms. In at least half the patients metastases were present at diagnosis. As this tumour, since the Nobel prize winning work of Huggins and Hodges in 1940, was known to be androgen dependent, all these patients were placed on either female hormones or underwent bilateral orchidectomy. Their median survival was a couple of years.

    In patients with localised disease many were treated by observation only, some had radiotherapy, some radical surgery, and some were started on hormone treatment immediately. Given the apparently slow nature of disease progression and competing mortalities in this age group, it was a perception, supported by the scientific literature, that all treatments had broadly similar survival curves. The concept in this group was that more men died with their prostate cancer rather than of it. At least half the men who died from prostate cancer were …

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