[Natural history and prognostic factors of prostate cancer]

Our present knowledge of the natural history of cancer of the prostate has been acquired from anatomical and clinical observations. They have led to identification of the main prognostic factors of the disease, but as long as the biological and molecular mechanisms implicated in its development remain obscure, our knowledge is incomplete and treatment of its various stages can only be orientated empirically. The main problems which should be resolved by prognostic indications are found at two critical points of the disease: 1) in the case of localised cancer, avoiding radical treatment (surgery or physiotherapy), either for a small, stable tumour discovered by chance (occult cancer) or for an apparently localised tumour but where surgery alone would be ineffective because of a high positive margin or a high metastatic potential; 2) in the case of advanced cancer, to estimate the beneficial effects of early hormonal or nonhormonal treatment on the quality of life and on patient survival. Identification of simple prognostic parameters also aims to reduce the health cost involved in this type of cancer and to increase patient comfort by simplifying initial and subsequent investigations. Prognostic factors include both clinical data and laboratory chemistries. The latter are still the object of numerous and diverse studies involving basic science. The increasing diversity of such studies and preliminary publication without correlated large series has so far precluded judging the reliability of such factors for clinical use. In practice, tumoural volume and stage remain the two factors which can estimate the risk of progression when prostatic cancer is detected microscopically.(ABSTRACT TRUNCATED AT 250 WORDS)