Symptoms and diagnosis of prostate cancer

Prostate cancer is unique in that it progresses very slowly. For this reason, the early stages of the disease are asymptomatic and difficult to detect. 

At Institut Curie, in order to diagnose the disease, the patient first meets with a doctor who performs a clinical examination, known as a rectal exam, to palpate the prostate and check its consistency. The doctor then prescribes a blood test to establish the level of PSA (prostate-specific antigen). The level of this protein in the blood gives a strong indication of the likelihood, or otherwise, of the presence of a cancerous tumour. 

If the doctor finds that cancer is likely (prostate hard to the touch, high PSA levels), the patient should be seen by a urologist. The latter will prescribe a prostate biopsy under local anaesthesia - an operation involving the removal of small fragments of tissue. These are then analyzed under a microscope by an anatomopathologist, who can determine whether the cells removed are cancerous. 

Based on these results, Institut Curie teams (urologist, oncologist, radiotherapist) meet to decide whether or not to proceed with an extension assessment (MRI, CT scan, PET scan or scintigraphy). The aim is to determine whether cancer cells have spread to the lymph nodes near the prostate or to other organs in the body (metastases, cancer cells that migrate from a cancerous site).

Several stages in prostate cancer

• Localized cancer: only affects the prostate;
• Locally advanced cancer: extends beyond the prostate to adjacent organs, but has not spread to the pelvic lymph nodes;
• Cancer with pelvic lymph node involvement.

Each of these is classified into three sub-groups according to its stage: low-risk, intermediate-risk and high-risk.

• Finally, metastatic cancer: in this case, secondary tumors are found elsewhere in the body, at a distance from the pelvic region.

Once a complete diagnosis has been made, Institut Curie medical teams set up a treatment protocol.