Recommandations en onco-urologie 2016-2018 du CCAFU : Cancer de la prostate

19 novembre 2016

Mots clés : (MeSH) Cancer de la prostate, Diagnostic, Traitement, recommandations, (MeSH) Prostate, Cancer, Diagnosis, treatment, guidelines
Auteurs : E. Bey, O. Gaget, J. Jund, C. Overs, O. Skowron
Référence : Prog Urol, 2016, 16, 27, S95, suppl. S1

Objectif

Le but du Comité de cancérologie de lʼAssociation française dʼurologie était de proposer une mise à jour des recommandations dans la prise en charge du cancer de la prostate (CaP).

Méthodes

Une revue systématique (Medline) de la littérature de 2013 à 2016 a été conduite par le CCAFU concernant les éléments du diagnostic, les options de traitement et la surveillance du CaP, en évaluant les références avec leur niveau de preuve.

Résultats

Les recommandations précisent la génétique, lʼépidémiologie et les moyens diagnostiques du CaP. Lʼimagerie par résonance magnétique (IRM) est lʼexamen dʼimagerie de référence du cancer localisé. Le score de Gleason a été redéfini par lʼInternational Society of Urological Pathology (ISUP) en cinq groupes pronostiques. Les moyens thérapeutiques ont été détaillés, puis recommandés en fonction des situations cliniques. La surveillance active (SA) est une option thérapeutique de référence pour les tumeurs de faible risque évolutif. La chirurgie reste une solution thérapeutique majeure du CaP localisé. Elle doit être envisagée dans un cadre multimodal pour les formes à haut risque. La radiothérapie doit utiliser une technique conformationnelle tridimensionnelle si possible en modulation dʼintensité à une dose > 76Gy. Lʼhypofractionnement modéré apporte un contrôle biochimique équivalent sans augmentation majeure de la toxicité. LʼHT courte peut être associée à lʼirradiation pour les tumeurs de risque intermédiaire « fort ». Pour les formes à haut risque, lʼassociation à une HT longue reste la référence. LʼHT est le traitement de fond au stade métastatique. La prévention des effets secondaires de lʼHT est fondamentale. Lʼhormonochimiothérapie de première ligne pour le traitement des CaP métastatiques hormono- et chimio-naïfs est le traitement standard en cas de cancer dʼemblée métastatique chez les patients dont lʼétat de santé est compatible avec lʼusage de docétaxel. Chez les patients présentant un cancer de prostate résistant à la castration (CPRC), lʼapport des nouvelles thérapies qui ont émergé ces dernières années aide à mieux contrôler la progression tumorale et à améliorer la survie.

Conclusions

Cette actualisation des recommandations françaises doit contribuer à améliorer la prise en charge des patients porteurs dʼun CaP.

© 2016 Elsevier Masson SAS. Tous droits réservés.

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