le suivi fait aussi bien que la chirurgie

Les conclusions de l’étude du NEJM (acccessible en ligne)

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer — NEJM
▻http://www.nejm.org/doi/full/10.1056/NEJMoa1606220#Top

CONCLUSIONS
At a median of 10 years, prostate-cancer–specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring.

Au total (dernier paragraphe de l’article):

At a median follow-up of 10 years, the ProtecT trial showed that mortality from prostate cancer was low, irrespective of treatment assignment. Prostatectomy and radiotherapy were associated with lower rates of disease progression than active monitoring; however, 44% of the patients who were assigned to active monitoring did not receive radical treatment and avoided side effects.5 Men with newly diagnosed, localized prostate cancer need to consider the critical trade-off between the short-term and long-term effects of radical treatments on urinary, bowel, and sexual function and the higher risks of disease progression with active monitoring, as well as the effects of each of these options on quality of life. Further follow-up of the ProtecT participants with longer-term survival data will be crucial to evaluate this trade-off in order to fully inform decision making for physicians and patients considering PSA testing and treatment options for clinically localized prostate cancer.

Une publication antérieure de la même étude permet d’avoir une indication sur la valeur du PSA aux taux retenus comme test de détection d’un cancer, en particulier localisé (versus faux positif)
▻http://www.ncbi.nlm.nih.gov/pubmed/25163905?dopt=Abstract

Of the 8566 men with a PSA concentration of 3·0-19·9 μg/L, 7414 (87%) underwent biopsies. 2896 men were diagnosed with prostate cancer (4% of tested men and 39% of those who had a biopsy), of whom 2417 (83%) had clinically localised disease (mostly T1c, Gleason score 6).