Genotyping should be considered for men from families with breast and ovarian cancer. Very close surveillance is recommended for these patients (Strength rating : STRONG). The indication for active surveillance of these patients with a specifically high risk for aggressive forms should be carefully weighed.

However, it appears that patients with BRCA2 mutations are at high risk for reclassification if placed on active surveillance. More than 150 genetic variants have been associated with an increase in the risk of PCA in ethnically diverse populations ДЄt present, there is no validated specific treatment for patients with hereditary prostate cancer. Polygenic inheritance is more difficult to analyse. If BRCA1 mutation is present, the risk of having PCA appears to be significantly increased (RR 1.35 (95% CI: 1.03вЂ“1.76)), but without any specific risk of aggressiveness. BRCA2 mutations could be associated with a PCA risk of 2.64 (95% CI: 2.03вЂ“3.47), an aggressive form, with a decrease in specific and overall survival. The characteristic of monogenic hereditary cancers is early age of onset, and a high level of aggressiveness in BRCA2 and HOXB13 mutations. The most commonly described genes involved in monogenic inheritance are DNA repair genes (including BRCA2, BRCA1 and ATM) and the HOXB13 gene. Hereditary PCA meets criteria that should be systematically identified: number of cases of prostate or breast cancer in the family, the distribution in a family branch and the age of onset ( Table 1). There are two types of genetic predispositions to prostate cancer (PCA): monogenic inheritance, which is rare (5% of the cases) and polygenic inheritance, which is predominant (95% of the cases). Prostate cancer is the cancer for which the weight of heredity is predominant, with family history being the most powerful risk factor. Le texte complet de cet article est disponible en PDF.Д®stablishing the presence of genetic abnormalities in prostate cancer (PCA)ГЊ involves two distinct clinical issues: identification of hereditary forms of the disease (search for germinal mutations), and identification of somatic mutations (present only in the tumour) which is predictive of the response to certain targeted therapies in metastatic cancers.

Cette actualisation des recommandations franГ§aises doit contribuer Г amГ©liorer la prise en charge des patients porteurs dвЂ™un cancer de la prostate. Chez les patients prГ©sentant un cancer de la prostate rГ©sistant Г la castration (CPRC), lвЂ™apport des nouvelles thГ©rapies qui ont Г©mergГ© ces derniГЁres annГ©es aide Г mieux contrГґler la progression tumorale et Г amГ©liorer la survie.Д¬onclusion. Le traitement ciblГ© des mГ©tastases est en cours dвЂ™Г©valuation. Le traitement local du cancer de la prostate par radiothГ©rapie amГ©liore la survie des patients oligomГ©tastatiques synchrones. Les donnГ©es rГ©centes amГЁnent Г recommander la SAd Г une hormonothГ©rapie de nouvelle gГ©nГ©ration (apalutamide ou enzalutamide) chez les patients mГ©tastatiques synchrones ou mГ©tachrones, quel que soit le volume tumoral. Dans cette situation, lвЂ™association de la SAd Г lвЂ™abiratГ©rone est Г©galement un standard thГ©rapeutique quel que soit le volume tumoral. Le docГ©taxel associГ© Г la SAd amГ©liore la survie globale en premiГЁre ligne du cancer de la prostate mГ©tastatique synchrone. La suppression androgГ©nique (SAd) reste le traitement de fond au stade mГ©tastatique. La radiothГ©rapie de rattrapage prГ©coce est recommandГ©e en cas de rГ©cidive biologique postprostatectomie totale. La surveillance active est une option thГ©rapeutique de rГ©fГ©rence pour les tumeurs de faible risque Г©volutif. Les moyens thГ©rapeutiques sont dГ©taillГ©s et recommandГ©s en fonction des situations cliniques.

LвЂ™imagerie par rГ©sonance magnГ©tique (IRM), examen dвЂ™imagerie de rГ©fГ©rence du cancer localisГ©, est recommandГ©e avant la rГ©alisation de biopsies prostatiques. Les recommandations prГ©cisent la gГ©nГ©tique, lвЂ™Г©pidГ©miologie et les moyens diagnostiques du cancer de la prostate, les notions de dГ©pistage et de dГ©tection prГ©coce. Une revue systГ©matique (Medline) de la littГ©rature de 2018 Г 2020 a Г©tГ© conduite par le CCAFU concernant les Г©lГ©ments du diagnostic, les options de traitement et la surveillance du cancer de la prostate, en Г©valuant les rГ©fГ©rences avec leur niveau de preuve. Le but du ComitГ© de cancГ©rologie de lвЂ™Association franГ§aise dвЂ™urologie est de proposer une mise Г jour des recommandations dans la prise en charge du cancer de la prostate.

Flacon ecbu