Thus, PAP is not a good screening test for the detection of resectable prostate carcinoma. PSA is more sensitive and specific than PAP and in cases in which there is no evidence of metastatic disease, PSA should be performed first. Controversy exists as to whether or not early detection of prostate carcinoma and subsequent surgery will result in increased survival. This is due to the fact that many more men die with prostate carcinoma than die from it. Endocrine therapy is for advanced metastatic Ca.
Estrogens inhibit testicular androgen synthesis directly.
Their main effect, however, appears to be the suppression of pituitary LH secretion with a secondary decreased testicular output of testosterone. The bony metastases may be osteolytic, but also frequently osteoblastic. Lymph node spread occurs frequently and often precedes spread to the bones. It occurs initially to the obturator nodes, fol lowed by perivesical hypogastric, iliac, presacral and para-aortic nodes. Metastases to lymph nodes in apparently localized prostatic cancer have a significant impact on the prognosis.