[Treatment of cancer of the prostate]

The incidence of prostate cancer has increased constantly over the last years. Treatment, whatever the stage of disease, remains controversial. Poor prognosis in patients with a localized tumor and lymph node metastases usually excludes curative therapy. Simple resection could be a reasonable option in cases with well or moderately well differentiated localized cancer, especially if life expectancy is less than 10 years. The real problem is to identity potentially aggressive cancers since an improvement in quality of life is an important element in caring for patients with cancer of the prostate. Survival rate at 15 years in patients with localized tumors after total prostatectomy appears to be comparable with that in the general population of the same age without cancer of the prostate. Conformational radiotherapy could allow more extensive irradiation of the prostate gland without touching the neighboring organs (rectum, bladder, head of the femoral bone). The dose should reach 80 Gy. Hormone treatment is currently used as first intention treatment in patients with metastase prostate cancer. Response rate is approximately 80%. Within 2 years, 8 out of 10 patients develop hormone resistance. Complete androgen suppression could improve survival times and quality of life in approximately 15% of the patients, although it is not possible at the present time to identify prior to treatment those patients who are susceptible responders. Chemotherapy has not been shown to be particularly effective in hormone-resistant cancer of the prostate. Prevention of cancer of the prostate is the next step to be accomplished.