[Update on screening, diagnosis and treatment of cancer of the prostate].
Recent progress in management of prostate cancer concern screening and treatment. The use of PSA and rectal examination advances the diagnosis by 5 to 10 years and shift the stage at the time of diagnosis toward curative localized intraprostatic disease. The impact of systematic screening remains controversial. However, individual screening explains, at least in part, the decrease of specific mortality due to prostatic cancer, recently observed in USA. PSA and lymphadenectomy have also contributed to a better selection of patients referred for local treatment by prostatectomy or radiotherapy. Radical prostatectomy is recommended for patients before 70 with T2 or less, Gleason score less than 8 and PSA less than 15 ng/ml. With that selection, disease-free survival reaches 75 to 80% at 10 years. Recently, dramatic improvement in radiotherapy techniques have been achieved, leading to a better local control by increasing the dose over 70 Gy without additional toxicity. Brachytherapy is also widely used for good prognosis localized disease. Limitant acute urinary side effects have been reported and results seem similar to those reported after prostatectomy or conformal radiotherapy. Recent randomized trials have demonstrated a benefit of early hormonal therapy concurrent with radiotherapy for patients with poor prognosis localized disease. For hormonoresistant metastatic disease, chemotherapy has been used with limited palliative benefit. New drugs are currently evaluated.
Chauvet
Bruno
B
Institut Sainte-Catherine, BP 846, 84082 Avignon Cedex. 2.
Villers
Arnauld
A
Davin
Jean-Louis
JL
Nahon
Sophie
S
D000726:Androgen Antagonists / Q000627:therapeutic use; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008403:Mass Screening; D010173:Palpation; D010353:Patient Education as Topic; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000628:therapy*; D011878:Radiotherapy / Q000379:methods
D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen