What treatments after the discovery of prostate cancer? Many options are now on the table to treat it with more efficiency and fewer side effects than twenty years ago. After a complete assessment, the therapeutic decision is made taking into account the patient's age and wishes.
It is not because the examinations have highlighted a small prostate cancer that it is imperative to start a treatment. When it comes to a microfocus of poorly evolving cancer cells, with a low aggressiveness score, the first option to consider is active surveillance. The most recent studies show, with more than ten years of hindsight, that more than 60% of these microfoci do not evolve and that patients will not need treatment. Active monitoring includes a PSA test every three months, an annual MRI and a reassessment of the strategy every year depending on the results. This strategy can affect up to 30% of men screened at an early stage.
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However, the majority of cancers diagnosed require treatment, either by surgery or radiotherapy, possibly combined with hormone therapy. "Here again, the therapeutic decision depends on age, possible comorbidities, the choice of the couple", explains Professor Zerbib.
After 75 years, radiotherapy is preferred
“Age is an important decision criterion. Before the age of 65, surgery is preferred. After age 75, radiotherapy is the main option. But you have to adapt to the wishes of the patient. And everything can be discussed. After 70, some men are in great shape and prefer surgery. Each option has advantages and disadvantages, although again there has been considerable progress. »
“After radiotherapy, there may be radiation complications in the bladder or rectum (much rarer thanks to the very precise targeting of the tumor by radiation), sometimes micturition and intimate disorders. After surgery, the risk of incontinence is now less than 5%. Sexual disorders have also decreased but remain around 50%. They are usually accessible to erectile dysfunction drugs. »
The improvement in care, in terms of quality and quantity of life, in recent years has been constant, including for forms with metastases. For localized forms, the healing percentage is now very high, around 90%. One thing is certain: the number of deaths from prostate cancer has been halved in twenty years, thanks to advances in early diagnosis and treatment, despite an increase in the number of cases.