[Management of advanced prostate cancer]

Prostatic adenocarcinoma is still often detected at an advanced stage, despite efforts for earlier diagnosis. Treatment depends especially on the stage of the disease at the time of diagnosis, on potential development which varies among types of tumours, on the presence of symptoms related to local-regional or general dissemination, and on age, which may be advanced in these patients. In stage C cancers with limited extraprostatic dissemination, the use of radical prostatectomy is debated. It may be indicated in some selected young patients in association with hormonal treatment. In other cases, androgen control alone (early, or only after appearance of symptoms) or pelvic radiation therapy can be used. In the presence of metastases, hormonal control is the best means of slowing disease progression. It is always indicated when the disease is symptomatic. The various means of hormonal treatment (surgical castration, LH-RH agonists, anti-androgens) should be considered with regard to the status of the patient, the manifestations of cancer and potential side effects of treatment. Surgery and/or radiation therapy is indicated for symptomatic relief in treatment of local dissemination (extension to the urinary tract, etc.) or bone metastases. In case of hormonal treatment failure, no other treatment is really effective, and survival is short. Symptomatic treatments are then used to increase quality of life.