A refined diagnostic approach thanks to multiparametric MRI
Prostate cancer, with 59,800 new cases in 2018, is the most common male cancer. “It’s a disease of the elderly. The increase in life expectancy and increasingly earlier diagnosis explain the increase in its incidence. On the other hand, mortality is stable, it should even decrease,” explains Dr Jochen Walz, head of the urology department at the IPC.
Multiparametric MRI has become a central tool to avoid overdiagnosis and overtreatment. “Thanks to prostate MRIs, we know where we need to biopsy to better detect cancers even in patients who do not present symptoms,” specifies Dr. Serge Brunelle, radiologist at the IPC. He adds: “The evolution of examination protocols and the use of the latest generation MRI allow examinations including artificial intelligence processes to optimize images. »
In addition, MRI is used as part of “active surveillance”, allowing observation of less aggressive forms of cancer without immediate intervention. This approach could further evolve: “The objective will be both to treat cancer as early as possible, that is to say even before any symptoms to have the best chance of cure, but also to avoid as many people as possible of having to do an unnecessary prostate biopsy,” concludes Dr. Brunelle.
Radiotherapy: shorter and better targeted treatments
Radiotherapy plays a central role in the treatment of prostate cancer, whether localized or metastatic. “New radiotherapy techniques make it possible to reduce urinary and digestive side effects on the one hand and the total number of sessions and therefore the duration of treatment on the other hand,” indicates Dr Naji Salem, radiotherapist at the IPC.
Thanks to accelerators integrating MRI imaging, the number of sessions can be drastically reduced. “The number of sessions can thus be reduced up to 4 weeks and in some cases up to one week with results in terms of healing equivalent to traditional 8-week regimens,” explains Dr. Salem. This increased precision allows organs at risk to be spared, thus limiting side effects.
Stereotactic radiotherapy, used in the treatment of metastases, combines effectiveness and speed. “This ablative effect makes it possible to sterilize the metastasis thanks to a high dose which is delivered in 3 to 5 sessions”, according to the IPC specialists.
Towards targeted therapies: PSMA lutetium
Since September 2023, a new therapeutic option has been available for patients whose traditional treatments with hormonal therapy and chemotherapy are not effective: 177 Lutetium PSMA vectorized radiotherapy. This treatment is based on a molecule that directly targets cancer cells by locally releasing strong energy.
Dr Alban Tauty, nuclear doctor at the IPC, specifies: “In one year, around fifty patients have been treated in our Center. » He adds: “This treatment has been developed for around ten years and mainly in Germany for Europe. It is now used all over the world. In PACA, three centers offer it, including the IPC. »
PSMA lutetium, administered by intravenous infusion, is generally well tolerated. However, side effects such as anemia, thrombocytopenia or neutropenia may occur, requiring joint monitoring by the oncologist and nuclear medicine physician.
By combining more precise diagnoses, personalized treatments and innovative therapies, the Paoli-Calmettes Institute is pushing the boundaries of prostate cancer care. These advances not only improve the chances of recovery, but also limit side effects for patients.
