Place de la chirurgie dans les tumeurs de la prostate à haut risque

[Oncological outcomes of prostate cancer surgery]

OBJECTIVE

Review of the oncological results of the radical prostatectomy as initial treatment of prostate cancer, according to the surgical approach and the risk stratification using D'Amico risk groups.

MATERIALS AND METHODS

Review of literature using Medline databases and MedScience based on scientific relevance. Research focused on the oncological results of the radical prostatectomy in series and meta-analysis published since 10 years, taking into consideration the surgical approach if mentioned.

RESULTS

The characteristics of the operated tumor highly impact the local control authenticated by the pathologic stage and the rates of positive surgical margins (PSM), in addition to the survival and the biochemical recurrence. Surgical technique adapted according to the tumor treated, was a constant challenge to the urologist, who counter balance between the oncological control and the conservation of urinary and sexual function by conditioning the type of radical prostatectomy. Results of radical prostatectomy acceptable in terms of PSM and survival are not influenced by the surgical approach but by the degree of surgical experience.

CONCLUSION

Results of radical prostatectomy show the efficient local control of prostate cancer, taking into consideration the oncological rules and indications validated by multidisciplinary meetings, based on the national (CCAFU) and European oncological guidelines. Tendency is going toward considering radical prostatectomy indicated for patients with higher risk of disease progression, so integrating surgery in a multidisciplinary personalized approach.

[SFRO 2010: congress highlights]

The 21st SFRO Congress during October 2010 focused on three main topics: prostate, radiotherapy technical innovations (including reirradiation) and quality of life. The pitfalls of IMRT (treatment time, number of monitor unit, low doses) are in competition with arctherapy dynamic techniques that offer reduction treatment time for an equivalent ballistic. These techniques with high dose gradient should be coupled with the better imagery of repositioning (IGRT) to ensure benefice. A prospective evaluation of toxicity, clinical benefit on tumor control but also on quality of life of patients is necessary. In many current and future clinical trials, quality of life related to health will be a relevant outcome measurement to secure the importance of treatment for the patient and the health system.