[Current therapeutic modalities for cancer of the prostate]

The treatment of prostatic adenocarcinoma is no longer limited to systematic and blind oestrogen therapy. Modern methods of investigation now allow us to determine with much greater precision the site, size and extent of the tumour as well as its histological features. Therapeutic modalities have also been improved and diversified and should now be selected according to the clinical stage of the tumour and, less precisely, according to its cellular aggressiveness potential (grade). Schematically, the major therapeutic approaches are as follows: because of their slow and uncertain natural history, incidental tumours (stage T1a and b) may not require any immediate treatment provided they are submitted to long-term surveillance. Cancers confined to the prostate gland (stages T1b, T2) warrant local therapy, which may be curative at this stage: radical prostatectomy or radiotherapy. The principal problem at this stage remains the difficult assessment of lymph node involvement. Locally more advanced cancers (stages T3-T4) are no longer amenable to curative treatment and opinions are divided between combined (and aggressive) local treatments and hormone therapy. Disseminated, metastatic cancers (stages D2, M+) are treated by hormone therapy which may consist of a combination of androgen deprivation by LHRH analogues or surgery and antiandrogens with a direct prostatic action. Although very effective in the majority of cases, the action of this treatment is limited in time. When the "hormone escape" phase is reached, no specific chemotherapy is available and only palliative measures can try to maintain an acceptable quality of life for a limited period of time.