What are the symptoms of prostate cancer?
The prostate cancer develops at the periphery of the gland. He remains silent for a long time. The appearance of signs often reflects an advanced stage of disease.


It is generally pain prostate or, more rarely, difficulty urinating, blood in the urine, sometimes symptoms resulting from the extension of cancer to adjacent organs (bladder, ureters, rectum).
Currently, most often cancer is diagnosed before the onset of symptoms, using the results of biological tests.

How is it diagnosed?
Two tests used to suggest the diagnosis:

• Digital rectal examination: in cases of cancer, prostate normally soft and smooth, may have a hardness irregular and painless. Note: a normal digital rectal examination does not eliminate cancer;
• The determination of PSA (or prostate specific antigen): if this biomarker is secreted specifically by the prostate, its elevation is not strictly synonymous with cancer. The PSA also increases in cases of benign (or adenoma) of the prostate, prostatitis (infection or prostate), or the waning of some technical moves (survey bladder, endoscopy.). An elevated PSA or rising is not enough to affirm the presence of cancer and must be confronted with the digital rectal examination and supplemented by other complementary examinations (ratio free PSA / total PSA, ultrasound).

These tests will determine if a prostate biopsy is necessary because only the biopsy will tell if this is a benign disease or cancer.

What are the differences between adenoma and cancer?
The adenoma or benign prostate is not cancer. This is an increase of non-cancerous prostate associated with aging. It often affects men over 60 years. Its symptoms are nearly the same as those of cancer.

What is the evolution of prostate cancer?
The prostate cancer develops at the periphery of the prostate, usually very slowly. When it occurs, is often a point already well advanced, with involvement of other organs (metastasis). Early diagnosis of this cancer before the onset of symptoms can quickly develop effective treatment and therefore the best guarantee of a possible cure.

Could there be a screening?
There is still no formal recommendations on the systematic biological screening for prostate cancer. However, the AFU (French Association of Urology) strongly recommends to achieve an annual rectal exam and a PSA determination:

• All men over 50 years
• All men at risk from 45 years: at least 2 close relatives affected by prostate cancer, African or Caribbean origin.

What are the different treatment of prostate cancer?
There are several types of treatment offered alone or in combination. They all have side effects. The chosen strategy is the result of a discussion between urologist, oncologist and general practitioner and reflects the characteristics of the tumor but also age and the patient’s wishes.

Surgery
The complete removal of the prostate or radical prostatectomy is for early cancers, strictly localized to the prostate. This intervention, rather “mutilating”, can leave significant effects (impotence, urinary incontinence); these are however declining due to recent improvements in operative techniques. We speak of prolonged remission than of healing when the PSA level remains undetectable 10 years after surgery. This prolonged remission is currently found in 80% of cancer cases diagnosed and operated at an early stage.

Brachytherapy
This technique involves implanting radioactive sources into the prostate tissue. It can be irradiated directly and maximum prostate while sparing the adjacent organs. It is reserved for cancers located in small volume prostates. It involves temporarily burns of the urethra and difficulty urinating, but less trouble on sexuality. It gives results comparable to surgery.

Radiotherapy External
The radiation is produced by an external source, focused on the prostate. Radiation therapy targets cancers located and obtained good results in cancer, but may cause irritation of the rectum. It can be used on bone metastases, especially to relieve pain.

Hormonal Treatment
Its principle: reduce the level of male hormones (which promote cancer development) and block the proliferation of cancer cells. Hormone therapy slows the progression of cancer with no cure. This treatment is reserved for advanced or metastatic forms, alone or combined with surgery or radiotherapy. Its major drawback is limited effectiveness over time (18 months to 2 years) and side effects including sexuality.

Chemotherapy
It is mainly used when hormone therapy becomes ineffective.