[What systematic work-up should be required for the patient with localized adenocarcinoma of the prostate?]

The systematic work-up for patient with clinically localised prostate cancer must allow a reconciliation of all the necessary elements to propose one or several therapeutical options. The evaluation must take into account the life's expectancy, and must precise the cancer progression and prognostic factors. The life expectancy depends out age, performance status and comorbidities. Digital rectal exam, PSA and Gleason score analysis are systematic. These tests allow the specialist to decide whether or not to complete the progression work-up by bone scan and pelvic CT. This first work-up should define if a patient will benefit from some curative local treatment. In case of palliative treatment or deferred treatment, the work-up highlights the specialist to decide the medical supervision. Some exams, systematic or not, are very specific from each therapeutic modality considered; they allow to precise individually the efficacy and toxicity prognostic factors for each therapeutic strategy. The final therapeutic decision is based at first on this objective data even if they are probabilistic, and finally on informed patients preferences.