Prostate cancer is the most common cancer among French men. There are more than 50,000 cases and 8,000 deaths annually. Risk is strongly correlated with age (a median age of 68 years) and can result in a variety of prognoses. While the diagnosis is most often made when the disease is in a localized stage, there are aggressive forms of prostate cancer that are immediately metastatic (spread aggressively.) The encouraging news is that, across all stages combined, the 5-year survival is greater than 90%.
The encouraging news is that, across all stages combined, the 5-year survival is greater than 90%
Prostate cancer cells are derived from the epithelial cells of the prostate which secrete Prostate-Specific Antigen (PSA). PSA levels are used as a screening mechanism and are the primary reference point for follow-up.
Prostate cancer cells are derived from the epithelial cells of the prostate.
These cells secrete Prostate-Specific Antigen (PSA), the level of which is part of the screening for this disease as well as the cornerstone of its long-term follow-up. The growth of tumor cells is stimulated by androgens and particularly testosterone. This makes prostate cancer one of the hormone-dependent cancers, like certain types of breast and endometrial cancer.
Note that certain types of prostate cancer are hereditary (particularly BRCA2 gene mutations).
Jacques, who has prostate cancer, tells you about his fight against the disease.
He tells you about the ups and downs of the past few years.
Prostate cancer has several histologies (type of tissue affected).
Prostatic adenocarcinoma is the most common.
whose treatment typically requires surgery and/or chemotherapy.
Types of prostate cancers are determined based on:
The different existing forms:
Hormone-sensitive response: effective response to castration, first-line (physical or chemical).
Hormone-resistant: the cancer does not respond to castration (primary resistance) or it progresses after an initial period of response to first-line hormonal treatment (secondary resistance).
Should this occur, these lesions will require their own specific treatment. In the event of symptomatic metastases and/or resistance to castration, an anti-resorptive bone treatment and vitamin-calcium supplements may be prescribed. Hormone therapy can also induce secondary osteoporosis.
Treatment for prostate cancer cause sexual disorders including postoperative or post-irradiation erectile dysfunction, libido and erection disorders, genital size reduction, etc. Various solutions are available.
Ask your doctor, various solutions are available.
Although prostate cancer is often asymptomatic, symptoms will vary depending on the stage of the disease.
When in a localized form,symptoms may appear but not be cancer-specific and may be linked to other non-cancerous prostate pathologies.(a prostatic adenoma or ‘large prostate’) or prostatitis (inflammation or infection of the prostate).
Urinary troubles are common, including:
Blood in the sperm
Unusual fatigue, weight loss
Screening is critical due to the asymptomatic nature of the disease.
PSA is a specific indicator of prostate health. Annual monitoring of PSA typically begins from age 50 or earlier for those who have a family history of prostate issues/cancer. A high level or a continuous increase of this marker will typically lead to further tests, including clinical examination (digital rectal examination for prostate induration) and a prostate MRI (Magnetic Resonance Imaging) scan. In cases where the patient has a pacemaker, a contrast ultrasound can replace the MRI.
An accurate diagnosis can only be made from prostate biopsies performed by image fusion on MRI. The biopsy results will be given a Gleason score, which ranges from 6 (good prognosis) to 10, to determine the disease’s level of aggression. The MRI will also determine the tumor size, another prognostic factor.
Treatment options will be determined by the initial diagnosis, factoring in the cancer’s level of aggression. Additional exams including bone scintigraphy, CT scans and Positron Emission Tomography (PET) scans may be necessary, particularly in locally advanced forms.
The main risk factors for prostate cancer are:
Age
Endocrine disruptors
(such as chlordecone)
For biopsies that indicate a mildly aggressive cancer, active surveillance may be a viable option. This approach would involve an MRI and biopsies in the first year, and additional treatment in case of progression.
In the case of progressive localized prostate cancer,options include surgery and/or radiation therapy.
Surgical treatment is called a prostatectomy. This consists of removing the prostate, the seminal vesicles and, if necessary, the neighboring lymph nodes that drain the prostate. Prostatectomy is recommended for localized tumors but becomes more questionable with locally advanced tumors. (Tumors that have spread to the seminal vesicles and/or lymph nodes.) Typical complications after surgery include incontinence (the frequency of which has markedly decreased due to improved surgical techniques) and sexual disorders, particularly erectile dysfunction. Surgical techniques are the same in conventional surgery and robot-assisted laparoscopy.
Radiation therapy is used to target tumor cells in the prostate and possibly the seminal vesicles and lymph node areas. The specifics of radiation treatments (intensity, number of sessions, etc.) depend on the stage of the cancer, and they are always delivered with care to protect neighboring organs. In aggressive forms of prostate cancer, radiation may be combined with hormonal treatment to reduce the risk of relapse.
Other treatment options are sometimes available, including brachytherapy, ultrasound and other less established techniques. It is not always easy for the patient to choose the best course of action and a second opinion may be necessary.
Regardless of the treatment type, recurrence is possible, usually indicated by a rise in PSA level. A PET scan or prostate-specific membrane antigen (PSMA) test can determine if the recurrence can be treated locally.
In the event of recurrence after prostatectomy, radiation therapy will likely be suggested.
In the event of recurrence after radiation therapy, the therapeutic choices are not well established. Prostatectomy may be an option, but the consequences can be more serious. Other treatments including localized stereotaxic radiation, brachytherapy, focused ultrasound, cryotherapy, etc, may be suggested.
If the relapse is in the lymph node or bone, radiation therapy is usually recommended.
In the event of metastatic prostate cancer, hormonal therapy will usually be recommended. It involves pituitary stimulation aimed at stopping the production of testosterone by the testes, possibly in conjunction with an anti-androgen treatment.
In some cases, chemotherapy or immunotherapy will be considered. In these metastatic forms, local treatment of the prostate by radiation therapy may improve survival. New hormonal therapies have also been shown to significantly improve survival rates for patients with advanced tumors.
In certain locally advanced forms of prostate cancer, endoscopic surgery will be performed to unblock the prostatic urethra or repermeabilize the ureters.
Lastly, as with any cancer diagnosis, the appropriate therapeutic strategy should be determined in consultation with a multidisciplinary medical team.
