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Pink October has made its way. Breast cancer screening awareness campaign is now well recognized by the general public. However, less is known about “Movember”, its masculine equivalent and which is the contraction of “mustache” and “November”. Since 2003, thanks to the Australian NGO Movember Foundation Charity, men around the world have been invited to grow a mustache during the month of November to raise awareness and raise funds for research on male diseases, in many of them I’m prostate cancer.
Growing a mustache might sound anecdotal, but it may ultimately be effective in starting a conversation about prostate cancer and the need to get tested. A friend, who participates in Movember every year, told me: “Obviously wearing a mustache when you’re not used to it raises questions. Suddenly, this makes it possible to evoke prostate cancer, a subject not always easy to address. However, the earlier the cancer is treated, the better. ”
Why do we care so much about prostate cancer?
First, prostate cancer is the most common cancer in men after age 50 and the second leading cause of cancer death in men. According to international data, one in seven men will have a case of prostate cancer in their lifetime.
Second, prostate cancer usually grows slowly. So if it is detected early enough, it is almost always possible to cure it, with the treatments currently available.
Hence the question of how to detect prostate cancer, at an early stage, right from the start?
This is possible by examining the prostate – digital rectal exam or TR –
performed by the urologist, combined with a simple blood test of the PSA dosage. This early diagnosis helps prevent many deaths related to this form of cancer.
It is recommended to perform these routine tests from the age of 50. These tests should be done from the age of 40 if you are at risk, that is, if you have a family history of prostate cancer. Also, this annual screening test is not recommended for men over the age of 75.
The diagnostic process
The first stage of diagnosis therefore consists in having a digital rectal examination with a urologist, as well as a PSA test in the blood. If digital rectal examination is suspicious (painless induration) and / or elevated PSA (greater than 4 ng / mL), a prostate biopsy is required. It should be noted that PSA is specific for the prostate and not for prostate cancer, especially since other conditions, such as benign hypertrophy, inflammation or infection, can lead to an increase in the level of PSA.
The urologist will often use other tests to improve the selection of candidates for prostate biopsy. These are urine tests (PCA3) or blood (Phi, 4 Kscore) or even a radiological examination, in particular multiparametric magnetic resonance imaging, whose sensitivity is 85%. The interest of this radiological examination remains its ability to locate the area or areas where cancer cells are found in the prostate. This helps ensure a targeted biopsy, improving results and reducing false negatives, which were common before the era of MRI. If prostate cancer is suspected, the urologist suggests a prostate biopsy. This examination serves to confirm the diagnosis, as well as to determine the severity and aggressiveness of the disease, and therefore its prognosis.
The biopsy is performed on an outpatient basis, under local anesthesia. It consists of coring the prostate with a very fine needle, transrectally or perineally, under ultrasound control (most of the time) or MRI in some cases.
Therapeutic Advances
If the presence of a tumor is confirmed, further radiological examinations are needed to determine the degree of its extension: localized, locally extensive, or metastasized. Pet Scan can detect metastases.
Total prostatectomy or removal of the prostate is the ideal treatment if the tumor is localized. Currently, this can be done using a robot. And its advantages are numerous: reduced complications (lower risk of bleeding and infections), better safety (for continence and preservation of erection), less post-operative pain, a small scar, short hospitalization from one to two days and a rapid resumption of professional activity.
Similarly, conventional radiotherapy is being replaced by three-dimensional radiotherapy with considerable effectiveness and fewer side effects.
It should be noted that new hormonal and immunological treatments can greatly improve the prognosis of patients with advanced cancer who have bone metastases.
Dr Sleiman Merhej is a professor of urology.
Pink October has made its way. The breast cancer screening awareness campaign is now well recognized by the general public. However, less is known about “Movember”, its male equivalent, which is the contraction of “mustache” and “November”. Since 2003, thanks to the Australian NGO Movember Foundation Charity, men …
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