[Prostate cancer treatments in Belgium]

The authors present a flyover of current management of prostate cancer. The topics include active surveillance, surgery, radiotherapy, high-intensity focalized ultrasound (HIFU). Current hormone treatment modalities as well as chemotherapy for hormone-resistant prostate cancer (HRPC) management are also reported. Reasonable evidence has supported the safety and feasibility, during a period of 5-10 years, of an active surveillance regimen for men with low-risk prostate cancer. Radical prostatectomy is an effective form of therapy for patients with clinically significant prostate cancer. Outcomes are highly sensitive to variations in surgical technique. The risks of perioperative complications such as urinary and sexual dysfunction appear to be as great with robotic-assisted prostatectomy as with any other technique. External beam radiotherapy (EBRT) is an effective noninvasive form of curative therapy with a long-term risk of troublesome bowel and sexual and urinary dysfunction. EBRT can also be used in adjuvant manner or in combination. Brachytherapy, is a convenient effective form of radiotherapy targeted for selected patients with clinically confined cancer without evidence of extraprostatic extension on imaging. Excellent outcomes require meticulous technique. Acute urinary symptoms are frequent; and the long-term risks of proctitis and erectile dysfunction seem comparable to the risks associated with external beam radiotherapy. HIFU has been used widely in Europe for complete ablation of the prostate, especially in the elderly who are unwilling or unable to undergo more invasive radical therapy. For low- or intermediate-risk cancer, the short- and intermediate-term oncologic results have been acceptable but need confirmation in prospective multicenter trials presently underway. HIFU is associated with a risk of acute urinary symptoms requiring transurethral resection before or after HIFU. Erectile function has not been adequately documented after HIFU. HIFU holds promise for focal ablation of prostate cancer and in case of recurrence after EBRT. Androgen-deprivation therapy is not recommended for men with localized prostate cancer. For locally extensive cancer, androgen-deprivation therapy should be used alone only for the relief of local symptoms in men with a life expectancy of < 5 years who are not eligible for more aggressive treatment. Management of HRPC is actually accepted with docetaxel chemotherapy based regimens.