There has not been any consensus of opinion on the timing of chemotherapy and radiotherapy in the management of this uncommon fisease (a combination of primary small cell carcinoma and adenocarcinoma of prostate). Unfortunately sometimes it is only after reports of the management and management outcomes of rare clinical entities are reported and the literature on the management of such uncommon cases are reviewed that lessons can be learnt in order to guide clinicians and oncologists on what should be the correct approach and the correct timing of various modalities of treatment.

The outcome of these two cases would suggest that perhaps early timing of chemotherapy and radiotherapy in addition to hormonal management may be a better alternative approach. However, it is only after the results of early use of a combination of chemotherapy and radiotherapy in addition to hormonal treatment are reported from a number of centres are reported to give superior outcome that clinicians and oncologists would come to a consensus agreement regarding the timing of the chemotherapy and radiotherapy. (Early rather than late).

I would agree with the suggestion that perhaps early chemotherapy and radiotherapy should be the approach. Nevertheless, this is only conjectural in that nobody knows what the outcome of early chemotherapy and radiotherapy would be. It may be that the outcome would be good. On the other hand it may be that such an aggressive tumour may not respond to early radiotherapy and the current available chemotherapy regimens. Perhaps after the results of similar cases treated elsewhere are reported urologists and oncologists through out the world would come to a consensus opinion on the management of such cases.

With regard to the managent of cases like these two cases, the multi-disciplinary team always decides to refer such patients straight away to the oncologists who then decide upon the timing of all the various treatment modalities and this is done in the regional oncology centre. The Urologists also follow-up the patient but do not decide on the timing of chemotherapy or radiotherapy.

In view of the rarity of this clinical entity the two cases have been presented in a narrative way in order to outline the chronology of events to enable all practitioners to see and learn from problems that may be encountered at various stages of the management of thes types of cases. Even though this may be laborious for the reader it is my view that a synoptic approach would not enable readers to clearly appreciate all the problems associated with the management of this uncommon entity.