IMPORTANCE OF THE LEARNING CURVE IN REDUCING POSITIVE SURGICAL MARGIN RATE AND IMPROVING BIOCHEMICAL PROGRESSION FREE SURVIVAL AFTER RADICAL PROSTATECTOMY FOR CT3A PROSTATE CANCER

[What's new in 2008 in the field of basic and clinical research in prostate cancer?]

In 2008, prostate cancer was the subject of a large number of communications in international conferences. The most innovating and the most eventful studies that are likely to alter patient management and physician's daily practice were selected. The impact of prostate cancer screening and the interest of urine markers like PCA3 were evaluated. Active surveillance needs to be strongly evaluated and it is recommended to include patients in current stringent research protocol. The role of radical prostatectomy in the management of high-risk and/or locally advanced prostate cancer was discussed. Extended lymphadenectomy decreases the risk of biochemical recurrence significantly (50%). However, it remains a surgical and a technical challenge. Modalities of radiotherapy, hormontherapy and advantages of intermittent treatments were selected. Long-term androgen deprivation (3 years) affords a better oncologic efficacy compared to a limited 6-months treatment. It seems necessary to evaluate testosterone serum level as soon as there is a situation of hormone-resistant prostate cancer. An androgen deprivation therapy that leads to the lowest castration testosterone level is needed as this level is directly related to the rate of specific death.