[Current questions and controversies on the treatment of prostate cancer]

The treatment of prostatic adenocarcinoma is the subject of debate and controversy at all stages of the disease. At the initial "subclinical" stage, discovered in transurethral resection or prostatectomy specimens, the conservative approach generally adopted should sometimes be replaced by curative treatment in young patients or in the case of high grade cancers. The localised, intraprostatic stage is amenable to curative treatment. However, radical prostatectomy may not be indicated in the presence of lymph node metastases and the discovery of positive margins on histological examination of the resection specimen raises the question of the necessity and the chronology of complementary treatments. At the stage of locally advanced cancer, all therapeutic modalities have been proposed in various combinations. The most controversial question concerns neoadjuvant endocrine therapy prior to radical prostatectomy. Metastatic disease is treated by endocrine therapy. However, the necessity of complete androgen blockade chemotherapy has still not been demonstrated. No effective therapeutic solution has yet been found for "endocrine escape", but a number of palliative measures should improve the quality of the patient's limited survival.