Therapeutic strategies and treatments

If symptoms are not bothersome, the patient is in good health, and the tumor has been identified as small, localized - low risk - and showing no signs of progression, it is entirely possible to defer treatment and preserve patients' quality of life. This is often the choice made by Institut Curie teams. Close monitoring is carried out through two regular examinations: measurement of PSA levels in the blood (by a simple blood test) and a digital rectal examination (DRE) every six months. These are supplemented by a biopsy sample at one year, then every two to three years, depending on laboratory analysis of the tissue.

Surgery for prostate cancer

If it becomes necessary to initiate treatment, initial surgery is the standard treatment. This involves complete removal of the prostate and seminal vesicles. Prostatectomy is usually proposed for patients under 70. In the vast majority of cases, it is performed for localized low- or intermediate-risk cancers; more rarely for more advanced tumors. In these cases, it is performed in Institut Curie partner establishments (Hôpital Foch, Institut Mutualiste Montsouris, Hôpital des Diaconesses).

After the operation, patients may experience urine leakage, particularly during physical exertion. Over time, these leaks diminish and can be stopped with rehabilitation. With regard to sexuality, erectile function may be affected, but there are treatments available to improve it. Alongside this post-operative follow-up, the Institut Curie staff carries out laboratory analysis of the organs removed by the surgeon. This makes it possible to better define the characteristics of the cancer and, if necessary, to complement treatment with radiotherapy or hormone therapy.

More information about surgery at Institut Curie

Radiotherapy and hormone therapy

Radiotherapy is a completely pain-free treatment, for which Institut Curie has state-of-the-art arctherapy equipment: the machine delivering the rays rotates around the patient to multiply the entry points of the beams and their precision, and thus better protect nearby organs (rectum, bladder). To prepare for irradiation, the scanner is used to acquire anatomical data from the patient (contouring) to identify the precise organ to be targeted. A tattoo point is made on the patient's skin to position the rays perfectly for each session.

In certain locally advanced cases (with a risk of lymph node involvement), Institut Curie teams will opt for hormone therapy. Tumor growth in prostate cancer is stimulated by the male hormone testosterone. The aim of these treatments is therefore to temporarily halt testosterone production in order to prevent the cancer from developing. Depending on the treatment, drugs are administered either subcutaneously or orally. Hormone therapy is usually started before radiotherapy, and can be continued for up to three years, depending on the individual case.

In 5-15% of cases, doctors may find that the cancer has relapsed. The patient is then offered Curietherapy. For the past ten years, the Institute has been at the forefront of this treatment, for which the medical teams have the benefit of hindsight and reliable data. This involves placing a radioactive source inside the prostate whose radiation destroys the cancer cells. The preferred technique at Institut Curie is to implant grains of iodine-125 in the prostate, whose radioactive effect is perfectly controlled and diminishes over time.

More information on radiotherapy at Institut Curie