Prostate cancer is the most common cancer in men
It is most often revealed by an increase in the PSA (prostate-specific antigen) blood marker.
It can also be revealed by dysuria-type urinary disorders: difficulty urinating, blockage, etc.
More rarely, it is responsible for erectile dysfunction or blood in the urine (haematuria).
Diagnosis is confirmed by carrying out prostate biopsies which are done under local anaesthesia after identifying the suspicious lesions by prostate MRI.
The biopsies help to identify which areas of the prostate are affected and to determine the tumour’s differentiation, which is synonymous with its aggression. It is rated according to the Gleason score.
The MRI and the rectal examination help to assess the extent of the tumour and to determine if it crosses the capsule.
On completion of the assessment, the tumour is ranked according to the D’Amico classification as low, intermediate, or high risk.
For intermediate and high risk cancers, the assessment will also include a bone scintigraphy and a thoraco-abdomino-pelvic scan to search for remote lesions.
Therapeutic indications stem from the D’Amico stages for cancers localised in the prostate:
- Low risk: Depending on the patient’s wishes, active monitoring, radiotherapy, surgery, or brachytherapy are possible
- Intermediate risk: Radiotherapy +/- Hormone therapy, surgery, or brachytherapy
- High risk: Radio-hormone therapy +/- supplemented by brachytherapy; surgery to be considered in some cases.
In the majority of cases, the patient may have several choices: there are no bad ones.
In this case, it is important to meet with a urologist AND a radiation oncologist in order to explore all options and to choose the one that best suits you.
Prostate radiotherapy has improved significantly in recent years and whereas before it would have required 40 sessions, most patients can now be treated in 20 or even 5 sessions with stereotactic radiotherapy.
Prospective data shows that urinary toxicities over time are very low and that gastrointestinal toxicity affects only 1 to 3% of patients.
As for erectile dysfunction, it is less frequent than after surgery and at 2 years it is identical to those patients who have received no treatment.
For metastatic stages, prostate radiation can be offered in the event of oligometastatic disease (<4 bone metastases). The STAMPEDE trial has shown an improvement in the overall survival of patients who underwent radiation.
Radiotherapy also plays an important part in treating bone metastases: analgesic radiotherapy, treatment of epiduritis, etc.
