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Carcinosarcoma of the prostate is an extremely rare tumor. In the case of rapid tumor progression, especially after radiation therapy to the pelvis or after hormone deprivation therapy because of prostate cancer, this tumor entity should be considered, and immediate histological confirmation is required. The only curative therapy is immediate radical surgical excision. We report about the first case of a carcinosarcoma after salvage radiation therapy for local recurrence of adenocarcinoma of the prostate years after radical prostatectomy.

In an attempt to elucidate factors predisposing to the occurrence of urethral stricture after transurethral resection of the prostate, we performed a prospective follow-up of 178 patients over 12-20 months. We took account of 11 factors that we considered important. Urethral strictures developed in 14.04% of the patients. The resection operations were carried out by five different surgeons, who had different rates of stricture. The only one of the 11 factors studied that was found to involve a statistically significant risk was the presence of an indwelling catheter for more than 3 days. No other factor influenced the result. This patient group was compared with a group of 73 patients followed up for 12-60 months following transvesical prostatectomy. In this group only one stricture (1.36% incidence rate) was observed retrospectively. It seems that urethral ischaemia might increase the risk of urethral stricture. Urethral injuries are considerably less frequent with open prostatectomy. Therefore, we recommend transvesical prostatectomy for pronounced prostatic hyperplasias.

In a comparative and retrospective study, outcome was examined in two groups of patients with incidental carcinoma of the prostate (stage T1a). In the 47 patients in the first group the carcinoma was kept under observation for 2-10 years without the administration of any treatment. During the mean follow-up of 5 years, the disease progressed in 11 (23.4%) of these patients, and 4 of them died. The other group was made up of 20 patients who underwent radical prostatectomy. The clinical and pathological staging were quite different in this group than in the other: more advanced stages and higher grades were seen in 10 patients, and the specimens taken from 6 were found not to contain any tumour. After a mean follow-up period of 4.5 years, all these 20 patients are alive with no evidence of disease. The management of patients with T1a tumour is still a problem. Observation only will be followed by progression in 23% of cases, while radical prostatectomy actually constitutes overtreatment in 30%. In conclusion, we prefer to perform prostatectomy in all patients with T1a carcinoma who are young and have a good life expectancy.

Three groups of patients with localized prostatic carcinoma are presented. One group of 42 patients was treated with radiation therapy. The second group of 43 patients was subjected to radical prostatectomy. The third group consisted of 42 elderly men with focal, incidental carcinoma who received no therapy. The preliminary results of management and observation are presented. Comparison of the two forms of management shows that radical prostatectomy gives better results than radiation in terms of cure, survival and disease progression. The probability of recurrence or metastases is very high in T3 lesions, despite radical surgery. In the group with incidental untreated carcinoma, a high incidence of progression was seen. It is concluded that these patients are at a certain risk despite old age and focal disease.