[Early diagnosis of cancer of the prostate. Value of systemic screening and of diagnosis in incidental cancer (stage A)].

Currently, radical prostatectomy has resurged due to techniques that permit preservation of the erector nerves and the routine use of the Walsh technique. Consequently, much interest has been focussed on methodology and technology that permit early diagnosis of prostate cancer. Until recently, patients with stage A cancer of prostate were considered to require no treatment and only regular control was recommended. Because an 18% incidence of disease progression has been demonstrated for stage A1 tumors over a period of 8 years and three quarters of the patients die from cancer, the approach has currently changed and radical prostatectomy is now recommended for relatively young patients (aged +/- 60 years). Walsh reported that more than 90% of patients with stage A1 tumors had preserved sexual potency after radical prostatectomy and 100% were completely continent. Radical surgery is evidently warranted in patients with stage A2 cancer of the prostate. The problem arises however in correctly staging the cancer in patients over 60 years and clearly establishing whether the tumor is stage A1 or A2. Surgery is not advocated for stage A1 tumors whereas radical prostatectomy is an indication for those with stage A2 tumors. The latter is an indication for repeat transurethral resection for multiple biopsy, and ultrasound-guided mapping and biopsy of the prostate. These currently depend on the preference of the physician instituting treatment.