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A consecutive series of 143 ultrasound guided biopsies of the prostate have been analysed. In 84 patients, in whom carcinoma was suspected by both digital examination and ultrasound, 49 cancers were confirmed histologically. In 29 patients in whom digital examination suggested cancer but ultrasound was normal, 2 cancers were confirmed. In 20 patients with a normal digital examination but a suspicious ultrasound appearance, no cancers were proven.

The prostate gland is being biopsied increasingly frequently, especially as a result of the visualisation of suspect areas on transrectal ultrasonography, using a variety of different needle types. We report only the third case of tumour seedling in the tract following a transperineal biopsy of a prostatic cancer with a 'Tru-Cut' needle. The literature is reviewed with regard to the characteristics and the incidence of seedling and the importance of including the perineum in any treatment option is emphasized.

A randomized, controlled trial of the treatment of metastatic prostatic cancer using either the LH-RH analogue Zoladex or orchidectomy is reported. The trial was conducted in the U.K. and Ireland and involved participants in 17 centers. The design of the trial is outlined and the response criteria discussed. The results show that the patient characteristics in the two treatment groups were comparable upon entry. Repeated administration of Zoladex every 28 days has been shown to be as effective as orchidectomy in lowering serum testosterone to castrate levels. The subjective and objective response rates were similar, as were the duration of response, time to treatment failure, and survival rates. The withdrawals from the trial and adverse reactions are discussed. These results, 10 months after the closure of recruitment to the trial, seem to indicate that Zoladex and orchidectomy are equivalent treatments and that Zoladex seems to be a truly medical alternative to surgical castration. Finally, other ongoing U.K. trials of the treatment of advanced prostate cancer are outlined.

This paper discusses the impact of new imaging technologies on our traditional confidence in digital rectal examination for help in diagnosis, biopsy staging and follow-up of patients with prostatic cancer. Ultrasound, particularly per-rectal ultrasound examination, has an important role in the differential diagnosis of smaller palpable abnormalities in the prostate and is especially useful for staging. It is also of value to measure prostatic response to treatment.