Choice of treatment for prostate cancer

The development of prostate cancer is well known. It is a tumour which usually develops slowly, during ten years or even more in some cases.

In this initial phase, the tumour is curable but it cannot be detected by current methods of diagnosis.

Advanced prostate cancer, multiple bone metastases

Advanced prostate cancer, multiple bone metastases

In the following phases, for two or three years, prostate cancer is detectable and curable. This so-called phase of curability is ideal for diagnosis and making therapeutic decisions.

At this stage, patients generally show no symptoms and diagnosis is usually derived from measuring abnormal levels of PSA when the prostate cancer is localised and encapsulated.

The last stage of development of the cancer is the longest. When the prostate cancer is no longer curable, subsequently treatment can only be palliative.
However, this tumour remains long without symptoms, and then intense pain begins, with respect to urinary problems, and pains caused by metastases, particularly in the bone.

Palliative treatment, hormonal blockage of the secretion of testosterone, then chemotherapy improves the comfort and the quality of life of the patient and delay inevitable fatality from cancer.

It is essential, then, notably for patients below 75 years of age, to make an early diagnosis of prostate cancer so as to offer the patient the possibility of cure. The therapeutic choices will be more aggressive, the younger the patient and the greater his life expectancy.

The management of prostate cancer, its diagnosis, the carrying out of prostate biopsies, the examinations are carried out by a urological surgeon.

There exists in France since 2004 with the ‘cancer plan’ an obligation for every practitioner treating cancer to present a report on each of his patients with a malign tumour to a meeting of ‘pluridisciplinary consultations’ on cancer within his establishment (The RCP).

The file of the patient is studied and discussed among practitioners of various disciplines, notably cancerology. This presentation is carried out in the initial phase of the sickness and a therapeutic plan is then established and communicated to the patient’s doctor.
The case of each patient may require further examinations if a development requires a change in direction of therapy (Worsening of; complications, relapse, recurrence, metastases etc.).

With the urologist and his general practitioner (GP), the patient chooses the course of treatment which he wishes to undergo among the therapeutic possibilities presented to him.