Quelles nouveautés en 2008 dans le cancer de la prostate en recherche clinique et en recherche fondamentale ?

25 mai 2009

Auteurs : V. Phé, M. Rouprêt, L. Salomon, M. Soulié
Référence : Prog Urol, 2009, 19, S29, suppl. S2

En 2008, le cancer de la prostate a fait l’objet de nombreuses communications dans les congrès internationaux. Les études les plus marquantes et les plus innovantes, susceptibles de modifier la prise en charge des patients et l’attitude thérapeutique des cliniciens ont été sélectionnées. L’impact du dépistage du cancer de la prostate et l’intérêt de marqueurs urinaires comme le PCA3 ont été évalués. La surveillance active nécessite d’être évaluée et ses modalités restent à définir. Actuellement, il est recommandé d’inclure les patients dans des protocoles. La place de la prostatectomie totale dans la prise en charge du cancer de prostate à haut risque ou localement avancé a été discutée. Le curage étendu divise par deux le risque de récidive biochimique, mais il pose encore des problèmes quant à sa faisabilité technique. Les modalités de la radiothérapie, de l’hormonothérapie et le bénéfice des traitements intermittents ont été abordés. L’hormonothérapie a montré son intérêt en traitement prolongé. Un traitement d’une durée de trois ans a plus de bénéfice qu’un traitement de six mois. Dans une situation de résistance à l’hormonothérapie, il faut effectuer un dosage de la testostéronémie afin de vérifier le seuil de castration. L’intérêt d’un traitement hormonal à l’origine d’une castration efficace (seuil de testostérone < 20 ng/dl) a été souligné pour réduire la mortalité spécifique.




 



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