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Prostate cancer

November 28, 2023 — published by Pyramidale Communication

At Pyramidale Communication Agency, we apply our expertise to a wide range of oncological conditions. One of them is prostate cancer.

Key numbers on prostate cancer

Prostate cancer is the most common cancer in France, accounting for 16% of all cancer cases and 28% of cancers in men.¹
The number of new cases diagnosed in mainland France in 2018 was nearly 60,000.^2,3
Prostate cancer is rare before the age of 50, and its incidence gradually increases with age.²
The median age at diagnosis is 69 years.²
It is a cancer with a good prognosis, even a very good one, with a five-year survival rate of 93%.^1,2
More than three-quarters of deaths occur after the age of 75, with a median age at death of 83.¹

What is prostate cancer?

Prostate cancer is a malignant tumor of the prostate gland that can be classified into three stages: localized, if the tumor is confined to the prostate; locally advanced, if it spreads to nearby tissues such as the seminal vesicles, bladder neck, or lymph nodes; and metastatic, if it spreads to lymph nodes or other organs.⁴

Family history, genetic predisposition, age, and ethnicity are the main risk factors for prostate cancer. Environmental factors and metabolic syndrome may also play a role.^1,5

Diagnostic criteria and medical care

Prostate cancer is usually asymptomatic. In most cases, symptoms are caused by benign prostatic hyperplasia (BPH) or infection. The presence of symptoms associated with prostate cancer is a sign of disease progression.⁴

The diagnosis and management of prostate cancer are based on the 2022–2024 recommendations of the French Association of Urology (AFU). ¹

The diagnostic approach primarily focuses on the early detection of high-risk prostate cancers due to their high mortality, the availability of diagnostic methods, and the existence of validated curative therapies.¹ The detection in the general population aged 50 to 75 includes the identification of risk factors (e.g., family history, ethnic origin), rectal examination, and PSA testing.^1,6

Imaging tests (e.g., ultrasound, MRI, PET/MRI, CT) are useful for diagnosing prostate cancer and assessing local, lymph node, and metastatic spread.¹ MRI is the reference imaging modality for localized prostate cancer and is recommended prior to prostate biopsies.¹

The approach to managing prostate cancer depends on several factors:

For localized or locally advanced prostate cancer, the standard management for tumors with a low risk of progression is watchful waiting. For patients with intermediate-risk tumors, radical prostatectomy is recommended, while multimodal treatment is indicated for high-risk or locally advanced tumors. In cases of biological recurrence following radical prostatectomy, early salvage radiotherapy is recommended.¹

For metastatic prostate cancer, androgen deprivation therapy (ADT) remains the standard treatment. However, for all hormone-sensitive metastatic prostate cancers, the combination of ADT and new-generation hormone therapy (NGHT) is now standard. For patients with metastatic disease of high volume and high risk at diagnosis, treatment with chemotherapy in addition to ADT + NGHT may be considered in eligible patients.
In patients with castration-resistant prostate cancer (CRPC), new therapies and precision medicine are helping to better control tumor progression and improve survival.⁷

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NGHT: New-generation hormone therapy
ADT: Androgen deprivation therapy

References:

Recommandations du comité de cancérologie de l’association française d’urologie – actualisation 2022-2024 : cancer de la prostate – diagnostic et prise en charge de la maladie localisée
Institut national du cancer. Le cancer de la prostate. Disponible sur le lien : https://www.e-cancer.fr/Professionnels-de-sante/Les-chiffres-du-cancer-en-France/Epidemiologie-des-cancers/Les-cancers-les-plus-frequents/Cancer-de-la-prostate
Santé publique France. Incidence des principaux cancers en France métropolitaine en 2023 et tendances depuis 1990. Publié le 4 juillet 2023. Disponible sur le lien : https://www.santepubliquefrance.fr/content/download/545862/3958555?version=1
AFU. Cancer de la prostate. Disponible sur le lien : https://www.urofrance.org/patient/pathologies-urologiques/cancer-de-la-prostate/
Barsouk A, et al. Epidemiology, Staging and Management of Prostate Cancer. Med. Sci. 2020:8(3):28. https://doi.org/10.3390/medsci8030028
Rozet F, et al. CCAFU french national guidelines 2016-2018 on prostate cancer. Progrès en Urologie. 2016;27(Suppl. 1):S95-S144.
Recommandations du comité de cancérologie de l’association française d’urologie – actualisation 2022-2024 : cancer de la prostate – prise en charge de la maladie métastatique et de la résistance à la castration. Disponible sur le lien : https://www.urofrance.org/recommandation/recommandations-du-comite-de-cancerologie-de-lassociation-fran-%CC%A7caise-durologie-actualisation-2022-2024-cancer-de-la-prostate-prise-en-charge-de-la-maladie-metastatique-et/