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Prostate Cancer
Director
Prof. Pierre Blanchard
Contact
+33 (0)1 42 11 47 99
E-mail
Understanding the Disease
Prostate cancer is the most common cancer among men in France, with nearly 60,000 new cases diagnosed each year. It is the second leading cause of cancer-related death among men, although the prognosis is generally favorable thanks to advances in treatment.
There are different types of prostate cancer; the most common form is adenocarcinoma, which develops in the cells that produce mucus and fluids. Other, rarer forms include small-cell carcinoma, which is more aggressive, and urothelial carcinoma. There are also sarcomas and neuroendocrine carcinomas, which are even rarer but often more aggressive. Each of these forms has specific characteristics that influence the choice of treatment and the patient’s prognosis.
In the vast majority of cases, this cancer progresses slowly and remains confined to the prostate gland for a long time. This is why early detection is essential: when treated at a localized stage, the chances of a cure are very high.
The aggressiveness of the cancer is determined primarily by three factors:
- The extent of the cancer (confined to the prostate, spread to the lymph nodes, or to other organs)
- The aggressiveness of the cancer cells as seen under a microscope (Gleason score).
- The level of PSA (Prostate-Specific Antigen) in the blood.
What is the prostate?
The prostate is a small, walnut-sized gland located below the bladder and in front of the rectum; it is found only in men. It surrounds the beginning of the urethra, the tube through which urine is expelled. Its main role is to produce part of the seminal fluid, which nourishes and protects the sperm. Until a man reaches his 40s, the prostate generally remains stable, but it can increase in size with age, which explains the frequency of urinary problems in aging men.
Prostate Cancer by the Numbers
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59,885
new cases in 2018
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69 years old
average age at diagnosis
Risk Factors
The main risk factor for prostate cancer is age. The disease is rare before age 50, but its incidence increases significantly after that age. The vast majority of cases are diagnosed in men over the age of 65. That is why regular screening is recommended starting at age 50, or at age 45 if there are additional risk factors.
Having a father or brother with prostate cancer increases your risk of developing it yourself. Certain genetic mutations, particularly mutations in the BRCA1 and BRCA2 genes, are also associated with an increased risk. These genes, known for their role in breast cancer, may also predispose a person to a more aggressive form of prostate cancer.
While some risk factors cannot be changed, adopting a healthy lifestyle helps reduce the risk of prostate cancer. A balanced diet, regular physical activity, and maintaining a healthy weight are among the identified preventive measures.
Gustave Roussy offers men with BRCA mutations the HARVEY program as part of its Interception initiative. This dedicated day combines information sessions, individual consultations, and prevention workshops led by experts in genetics, nutrition, and physical activity. The goal is to help each man understand his risk and take concrete steps to protect his health.
Symptoms
Symptoms to Watch For
Prostate cancer causes relatively few symptoms; as a result, it is usually discovered by chance during a routine checkup or medical examination. However, in some cases or at an advanced stage, symptoms may appear, such as:
- Frequent and/or urgent need to urinate.
- Difficulty urinating (needing to strain, difficulty starting or stopping the flow, a weak or interrupted urine stream).
- A feeling that the bladder has not been completely emptied after urinating.
- Burning or pain when urinating.
- Blood in the urine or semen.
Feeling a lump in the breast does not necessarily mean it is cancer
Just above the testicle is the epididymis, a small organ that often develops a cyst—a small lump that causes men a great deal of concern but is absolutely nothing to worry about.
If you have even the slightest concern—if you feel something unusual—don’t hesitate to make an appointment with your primary care physician as soon as possible. There’s no shame in that.
If you have any concerns, your primary care physician will order an ultrasound. This is a painless test that will determine with certainty whether the issue involves the testicle or the epididymis.
Coverage
The Urology Committee at Gustave Roussy treats patients with all types of prostate cancer.
The management (diagnosis and treatment) of prostate cancer requires the collaborative efforts of several physicians from various disciplines—including medical oncologists, surgeons, radiation oncologists, radiologists, and pathologists—working in collaboration with primary care physicians. Every major decision is made during multidisciplinary team meetings (MDTs). In some cases, the patient’s presence at a meeting may be required.
One-Day Treatment Intake
At Gustave Roussy, a rapid treatment assessment is offered to patients coming in for their first appointment following a diagnosis of localized prostate cancer. This initial visit, which takes half a day, includes consultations with a urological oncologist and a radiation oncologist, as well as a multidisciplinary team meeting, allowing for the development of a tailored treatment strategy (external beam radiation therapy, brachytherapy, surgery, hormone therapy, active surveillance) to be determined in consultation with the patients.
While treatment is usually necessary, it is rarely urgent, due to the slow progression of prostate cancer. In some cases, the patient may have a choice between several types of treatment. It is therefore important to take the time to understand the different treatments and their side effects. This is one of the goals of the initial consultation.
Treatments and Clinical Trials
The treatment of prostate cancer depends on the stage of the disease.
When the tumor is confined to the prostate, treatment options include:
Surgery.
Surgical treatment for prostate cancer involves removing the prostate and the seminal vesicles (radical prostatectomy). If surgery is necessary, it may be performed in some cases at Gustave Roussy or at Bicêtre Hospital, a partner of Gustave Roussy.
External beam radiation therapy.
Rays are delivered by a precision machine outside the body, with radiation beams converging on the prostate. Treatment consists of short daily sessions, with a total treatment duration of 7 to 8 weeks.
Hypofractionated radiation therapy—a rapidly evolving technique that reduces the number of radiation therapy sessions—is also available at Gustave Roussy.
Brachytherapy (internal radiation therapy).
Two brachytherapy techniques are currently offered at Gustave Roussy:
Conventional treatment using small radioactive seeds permanently implanted in the prostate using needles under general anesthesia
High-dose-rate therapy, which involves temporarily inserting catheters into the prostate, through which a micro-source of iridium-192 delivers very high doses of radiation. This treatment is generally administered in two sessions, prior to external radiation therapy.
Drug therapies.
These are based on:
Conventional hormone therapy (LH-RH analogs: administered by injection every 3 months, or oral peripheral antiandrogens) or next-generation hormone therapy.
Chemotherapy (alone or in combination), most often administered intravenously.
A patient with isolated biochemical recurrence (a rise in PSA levels) following surgery is treated either with salvage radiation therapy to the prostatectomy bed or with hormone therapy: various clinical trials are currently underway on this topic, and you may be offered participation in one.
After external beam radiation therapy or brachytherapy, a patient with biochemical recurrence is treated based on the rate of PSA rise: hormone therapy or active surveillance may be offered.
Metastases are tumor cells that originate in the prostate and have spread to other organs via the bloodstream or the lymphatic system.
Most often, prostate cancer metastases occur in the lymph nodes and bones. The initial treatment for prostate cancer metastases involves hormone therapy, the primary goal of which is to lower the level of testosterone (a male hormone) in the blood.
This hormone therapy involves either subcutaneous or intramuscular injections of medication (every month or every three months) or surgery on the testicles. Treatment with anti-hormonal tablets (peripheral antiandrogens) may be added.
When the disease is resistant to hormonal therapy, several options will be discussed:
Either a change in the hormonal therapy.
Chemotherapy using docetaxel, supplemented with estramustine if necessary.
Or the use of a bone-targeted treatment administered as a monthly intravenous infusion (zoledronic acid).
In addition, many promising drugs are available for this condition as part of clinical trials conducted at Gustave Roussy.
A dedicated radioligand therapy pathway for metastatic prostate cancer
At Gustave Roussy, the oncology and nuclear medicine teams have established a coordinated care pathway dedicated to patients with prostate cancer. During a single half-day visit, patients can receive joint follow-up from an oncologist and a nuclear medicine physician, facilitating access to radioligand therapies such as lutetium-PSMA-617 (Pluvicto) or radium-223 (Xofigo).
This pathway closely combines patient care and research. In particular, patients may be offered the opportunity to participate in the UNLOCK-PSMA translational study, which aims to gain a better understanding of the mechanisms underlying response and resistance to lutetium-PSMA-617 in metastatic prostate cancer.
Biopsies performed at different stages of treatment enable researchers to investigate markers associated with response or resistance. The aim is to better understand why some patients respond to treatment and to identify new therapeutic strategies when the disease becomes resistant.
Join a clinical trial
Many clinical trials are open to patients with cancer. Participating in a clinical trial provides access to innovative treatments while contributing to the development of new therapies.
Search
Prostate cancer is the focus of extensive research at Gustave Roussy, which has led to the development of increasingly effective treatments in recent years. Clinical trials are underway to evaluate other innovative treatments and techniques, as well as different administration regimens.
Research on prostate cancer is currently organized around three main areas:
- Predicting how the tumor will respond to chemotherapy and elucidating the mechanisms of resistance to prevent metastases and improve treatments.
- Identifying the characteristics of each patient’s tumor to enable personalized treatment.
- Developing therapies that are less toxic and less debilitating, yet just as effective, to improve patients’ quality of life.
Contacts
Chair of the Urology Committee,
Prof. Pierre Blanchard
Contact
Tel.: +33 (0)1 42 11 47 99
Appointments and Second Opinions
Alain's Testimony
Treated for prostate cancer at Gustave Roussy
I received radiation therapy for prostate cancer at Gustave Roussy. I was deeply touched by the kindness of the healthcare teams throughout my treatment.
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Mens November: Take care of your jewelry its precious!
November is the month dedicated to raising awareness and promoting prevention of male cancers, which include prostate, testicular, and penile cancers. The goal is to raise public awareness of these diseases—which account for approximately 63,000 new cases in France each year—and to encourage men to perform testicular self-exams, a simple step that can help detect a lump, the nature of which must then be determined through further medical examinations. Gustave Roussy has extensive expertise in the treatment of male cancers, particularly through its Genitourinary Oncology Committee, which is deeply involved in research on these diseases.
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La Dr Alice Bernard-Tessier récompensée par la Prostate Cancer Foundation
Basée aux États-Unis, la Prostate Cancer Foundation figure parmi les organismes les plus influents au monde dans la recherche sur le cancer de la prostate. Elle a remis à la Dr Alice Bernard-Tessier, oncologue à Gustave Roussy et actuellement aux États-Unis dans le cadre d’un partenariat avec le Dana Farber Cancer Institute, un Young Investigator Award. Ce prix, attribué pour la première fois à un chercheur français, distingue son projet de recherche visant à mieux comprendre les mécanismes de résistance à une thérapie ciblée afin de développer de nouvelles stratégies thérapeutiques.
Frequently Asked Questions
In its early stages, prostate cancer often causes no symptoms. In more advanced stages, certain signs may appear: difficulty urinating, frequent urination, bone pain, or blood in the urine. These symptoms are not specific to cancer and may also be related to other benign prostate conditions.
Screening relies primarily on two tests: a blood test to measure PSA (prostate-specific antigen) levels, and a digital rectal exam performed by a doctor. These tests help detect any abnormalities and guide patients toward further testing if necessary.
No. The vast majority of prostate cancers grow slowly and are not life-threatening, especially when detected early. In some cases, active surveillance alone may be recommended, without immediate treatment. Other, more aggressive forms, however, require prompt treatment.
Several treatment options are available, tailored to the stage of the disease and each patient’s profile: active surveillance, surgery (prostatectomy), radiation therapy, hormone therapy, or focal treatments. At Gustave Roussy, each case is discussed in a multidisciplinary team meeting (MDT) to determine the most appropriate course of treatment.
There is no surefire way to prevent it, but certain modifiable factors can reduce the risk: a balanced diet, regular physical activity, and limiting alcohol consumption. For men at genetic risk, personalized support is available, notably through the Interception program at Gustave Roussy.