Androgen Blockade… only palliative..

“….there was a reluctant realization that hormone manipulation, despite its sometimes dramatic effects, is only a palliative treatment…;


Textbook of Prostate Cancer: Pathology, Diagnosis and Treatment

Eds Amir V Kaisary, Gerald P Murphy, Louis Denis, Keith Griffiths

Martin Dunitz, £75, pp 384

The demonstration by Huggins and colleagues in 1941 of the effects of castration on prostate cancer was a breakthrough that won a Nobel prize and generated great optimism that cancer could be cured. As evidence gradually accumulated there was a reluctant realization that hormone manipulation, despite its sometimes dramatic effects, is only a palliative treatment; there were to be few substantial advances in the management of prostate cancer for the next 40 years.

Prostate cancer is the second commonest cause of cancer death in males. In the past decade there has been a quiet revolution in the management of the disease, and at last the profession, the media, and the public are demanding that more effort and resources are devoted to research and new treatments. This book is testimony to that renewed interest and covers the subject from the cancer‘s natural course, through its biology, evaluation, and surgical and non-surgical treatments, to the care of the patient in the final stages of the disease. It is a succinct and attractive summary of the current state of play from an international team. Although you could find more pages, and as many references, in the latest editions of the standard textbooks of urology, this book definitely gains from being easier to handle than even one volume of a textbook, though neither can do justice to the increasing number of new publications related to prostate cancer. In the year that Huggins’ work was published there were 42 citations on prostate cancer in the world literature, compared with over 2000 in 1998.

In spite of increasing attention and accumulating knowledge, advances in treatment that improve survival remain elusive. Furthermore, the slow progress of the disease and the age group affected means that we have to wait for 10 years or more before today’s exciting advances become tomorrow’s evidence based treatments. While we are waiting, this book provides a balanced and comprehensive overview of prostate cancer that urologists, oncologists, and, indeed, anyone interested in the disease will enjoy.

For urologists, prostate cancer demands a holistic approach and challenges our knowledge of the basic sciences, our operative skills, and our communication abilities. As one contributor looking to the future puts it, “We have to treat our patients with our minds on the science and our hearts on the patient.”


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Neville W Harrison, consultant urological surgeon


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