[Indications and results of exclusive radiotherapy in early prostatic adenocarcinoma]

Prostate adenocarcinoma incidence are rising rapidly, especially in early stages. Even if some of these carcinomas may be latent or slow growing either spontaneously or under hormonal therapy, most patients 75 years old or less presenting a localized tumor, T1b-c, T2, T3, N0, M0, whatever the grading, will require treatment with curative intent: radical prostatectomy, external beam radiation therapy (ERT) and/or brachytherapy. After ERT limited to the prostate or including seminal vesicles and/or pelvic lymph nodes, the overall survival and the survival without clinical evolution at 5, 10 and 15 years are good. However survival rates without biochemical evolution are about 30% lower and 70% or less at 5 years for the more favorable group (T < or = T2a and Gleason < 7 and PSA < 10 ng/mL). Brachytherapy alone yields good results for the same favorable group. In the unfavorable group (T > or = 2c and Gleason > or = 7 and PSA > or = 20 ng/mL), adjuvant hormonal therapy improves survival. Conformal radiation therapy allows an increase in dose to the tumor by about 15% without increasing complications. It can increase the biological remission rate in the intermediate group (T < or = 2a or Gleason > or = 7 or PSA > or = 20 ng/mL).