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Le cancer de la prostate: Acquis et challenges pour l'an 2000

Prostate Cancer: Acquired knowledge and challanged for year 2000

Andrologie volume 8, pages 373–382 (1998)Cite this article

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Quel que soit le stade et le degré d'évolution du cancer de la prostate, les principes des traitements, leur indications et les modalités de la surveillance sont en constante évolution. Le diagnostic précoce est accessible au clinicien qui dispose du PSA et du toucher rectal pour poser les indications des biopsies. Ceci permet aujourd'hui de traiter des patients à un stade précoce avec un meilleur pronostic lorsque le cancer est localisé à la glande. Les améliorations de la technique chirurgicale ont largement contribué à diminuer la morbidité postopératoire et celle-ci représente le traitement de référence. La radiothérapie reste une alternative au traitement chirurgical mais les résultats sont plus difficiles à analyser. Le traitement hormonal par déprivation androgénique est indiqué au stade des métastases. Les agonistes de la LHRH associés aux anti-androgènes représentent une alternative tout aussi efficace que la castration chirurgicale. Malheureusement, le pronostic des formes avancées reste sombre et imprévisible. Les objectifs pour les années à venir seront d'améliorer l'évaluation diagnostic du cancer de prostate et de mieux définir les indications en fonction des traitements disponibles; de mieux comprendre les effets du traitement hormonal et de proposer de nouveaux traitements pour les formes androgèno-indépendantes.

Abstract

Principles of the diagnosis and treatment of prostate cancer at any stage are still improving. Early diagnosis is accessible throughout the use of the PSA test associated with digital rectal examination which lead to indicate transrectal biopsies. This allowed to treat patients at an earlier stage and significantly improved prognosis in the case of organ confined disease. Progress made in the radical prostatectomy technique have contributed to decrease the postoperative morbidity and is the treatment of reference in clinically localized disease. Radiation therapy still remains a valuable alternative, however, results are more difficult to evaluate. Hormonal treatment using androgen deprivation is indicated at the stage of metastasis. LHRH agonist associated with anti antiandrogens are as much efficacious as surgical castration. Unfortunately, the prognosis of advanced disease remains unpredictable. Objectives for the future will be to improve the diagnostic and staging of prostate cancer et to better define therapeutic indications; better understand the effects of androgen deprivation; and to propose new therapies for hormone refractory cancers.

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  1. Service d'Urologie et Chirurgie de la Transplantation, Hôpital E. Herriot, 69003, Lyon

    M. Colombel, F. Blanc & J. M. Marechal

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Colombel, M., Blanc, F. & Marechal, J.M. Le cancer de la prostate: Acquis et challenges pour l'an 2000. Androl. 8, 373–382 (1998). https://doi.org/10.1007/BF03034574

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Basic and Clinical Andrology

ISSN: 2051-4190