Low-risk prostate cancer treatments

Two therapeutic options are currently offered for low-risk localised prostate cancer:

Active surveillance (therapeutic abstention) : Regular surveillance of the progression of the cancer by clinical examination, PSA assay every 6 months coupled with a digital rectal examination as well as a biopsy screen at 1 year and then every 2 to 3 years.

Radical treatment :

  • Surgery (prostatectomy): this consists of removing the entire prostate via open surgery or hand-assisted or robot-assisted laparoscopy (camera and instruments in the abdomen). This procedure can affect urinary continence (sometimes urine leakage) or sexual activity (erectile dysfunction).
  • External radiotherapy: radiotherapy with an external source of ionising radiation directed toward the prostate.
  • Brachytherapy: insertion of radioactive implants into the prostate. These implants emit radiation that destroys the cancerous cells of the prostate.
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At present, there is no consensus concerning the management of prostate cancer. It fluctuates between therapeutic abstention consisting of deferring the radical treatment (until signs of progression) and the immediate initiation of that radical treatment (curative), which can induce sexual and urinary sequelae.

Focal treatment :
Focal treatment is naturally adapted to localised prostate cancer as a targeted treatment of that part of the prostate that is invaded by the cancer, while limiting side effects.prostate_treatment_1There are 2 types of focal treatment :

1) Thermal focal treatment :

  • High-intensity focused ultrasound (HIFU): A probe is used that directs ultrasonic waves and heat to destroy the tumour. The HIFU technique is indicated for low-risk localised prostate cancers.
  • Cryotherapy (cryosurgery): consists of the implantation of fine needles into the prostate in order to freeze it. There is insufficient feedback to assess the long-term benefits of this technique.

2) Non-thermal focal treatment for low-risk localised cancer excluding very low-risk cancers:

  • Vascular targeted photodynamic therapy (VTP) : This therapy is based on the activation of a drug using a light of a specific wavelength.

Targeted therapies are treatments that specifically target the cancerous cells with the aim of thus preserving the healthy tissue and thereby reducing side effects.

Effects on quality of life:

Prostate surgery in general affects quality of life, particularly in relation to urinary function (typically incontinence) and sexual function (erectile dysfunction). It has an impact on the quality of life of the patient as well as that of his/her partner.

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Several validated international questionnaires are used to assess the quality of life of patients with prostate cancer:

      • IIEF15: Questions concerning erectile function
      • IPSS: Questions concerning urinary function
      • EQ5D: Questions concerning quality of life