This disease most often develops after the age of fifty, hence the importance of regular screening from this age onwards.
A paradigm shift
In recent years, however, several changes have shaken up the field. First, new treatments have been developed, such as next-generation hormone therapy, which, in the case of prostate cancer, reduces testosterone levels in the body and blocks its action on cancer cells, which slows the expansion of the tumor. Nuclear medicine has also made enormous progress in advanced cancers. Today, it makes it possible to create radioactive molecules that, once in the body, will attach themselves directly to metastatic prostate cancer cells in order to destroy them.
These new treatments not only offer excellent clinical results, but they also lend themselves readily to multimodal intensification, or the possibility of combining several treatments to improve their effectiveness. For example, the use of new generation hormone therapy with radiotherapy or chemotherapy, or both.
Then, not all prostate cancers are systematically treated. “Indeed, in about 20% of cases, the tumor is not aggressive, because it is still small. As this type of cancer generally develops slowly and is not associated with particular symptoms, continuous monitoring rather than specific treatment can sometimes be judicious in order to avoid treatment and its significant side effects such as incontinence and erectile dysfunction for as long as possible,” explains Pierre Bohanes.
Doctors therefore currently have several areas of action which enable treatment adapted to each person.
A new multidisciplinary and personalized approach
The diversification of treatment choices has also led to the creation of tumor boards in specialized centers, such as the Clinique de La Source. These meetings, which can be translated as “tumor advice,” bring together specialists. They include urologists specializing in surgery, oncologists, radiotherapists, and nuclear specialists. A place is also provided for the general practitioner for his or her in-depth knowledge of the person concerned. These meetings lead to a collegial decision-making process centered around the patient: each specialist gives his or her opinion on the case presented in order to define the best possible treatment option(s).
During these meetings, emphasis is placed on several factors: the aggressiveness and size of the tumor, the presence of metastases, or even the age of the sick person, their general state of health and their genetic background. Not only do these factors help doctors decide whether or not an intervention is necessary, but they also help decide what type of treatment to use. Indeed, international recommendations use all of these factors as decision-making criteria for the use of multimodal intensification. Pierre Bohanes explains: “For example, if metastases are detected, we will be able to add chemotherapy combined with treatments specifically targeting the prostate, in order to attack the cancer in a global manner.”
“However, we also take into account the opinion of the sick person,” Pierre Bohanes explains before continuing, “they can express a wish on the treatment they would like to receive, or even the one they would like to avoid.” Collecting all this information allows us to define an effective treatment that will best correspond to the wishes of the sick person, as well as their pathology.
After that?
Unfortunately, no matter how personalized and precise the proposed methods are, side effects often appear after the treatment period.
To understand, let’s go back to the prostate for a moment. It is a gland that forms a ring around the urethra just below the bladder and in front of the rectum. It produces a fluid that represents about 30% of semen and contains nutrients for sperm. The prostate is therefore essential for the reproductive system.
Side effects of prostate cancer treatments can commonly include urinary incontinence, erectile dysfunction, and even infertility. These symptoms often deeply affect those being treated and those around them and should not be taken lightly.
Pierre Bohanes explains: “At the Clinique de La Source, the support does not stop at the end of the treatment. Thanks to the “La Source à domicile” program, monitoring continues even after hospitalization in order to facilitate the return to normal life and manage the appearance of complications. » This follow-up can also include support from nurses specialized in oncology, or sessions with sexologists to promote good communication between couples in the event of erectile dysfunction following treatment.
The key word: screening
Prostate cancer is a disease in which prostate cells begin to proliferate uncontrollably and cause a tumor to form. “Because of its generally slow development, a large proportion of prostate cancer cases are diagnosed during routine check-ups, without the presence of warning symptoms,” adds Pierre Bohanes. However, several symptoms related to prostate cancer can appear when the cancer is at an advanced stage. These symptoms include the presence of blood in the urine or semen, difficulty urinating and persistent pain in the pubic region and lower back. If these symptoms appear and persist, you should immediately see a primary care physician who will, if necessary, refer you to a specialist center, such as the La Source Prostate Center.
As we have seen, prostate cancer is a disease that generally develops without causing warning symptoms. It is therefore important to talk about screening with your family doctor without waiting to have symptoms, from the age of 50. It is all the more important to get screened if cases of prostate cancer before the age of 65 are known in your immediate family, as well as if you are of African descent. Unfortunately, these two factors greatly increase the risk of developing prostate cancer. The screenings are very simple and in principle only include a blood test to quantify proteins produced by the prostate – PSAs – which can indicate the presence of cancer if they appear in too large quantities. A rectal exam is also recommended to assess the size and appearance of the prostate. A prostate MRI can then complete a positive screening. Pierre Bohanes specifies that due to a delicate interpretation of this examination, “the La Source Prostate Center performs a double reading by specialized radiologists in order to refute or affirm the interpretation of the imaging. If the MRI suggests prostate cancer, radiologically guided biopsies are performed and, if necessary, an appropriate therapeutic approach is proposed.
