Choosing between these options depends on many factors: cancer stage, Gleason score, age, general health and personal preferences of the patient. There is no universally “best” treatment — only options that are better or worse suited to each situation.
1. Surgery: total prostatectomy
Radical prostatectomy consists of completely removing the prostate and seminal vesicles, sometimes associated with the removal of neighboring lymph nodes depending on the stage. It is most often offered to men under 70 in good general health, and can be performed by different methods: open surgery, laparoscopy, or robotic assistance - the latter technique gradually becoming more widespread in French establishments.
A complete anatomopathological analysis of the removed prostate is then carried out, which sometimes makes it possible to refine the initial Gleason score and to decide, if necessary, on additional treatment (salvage radiotherapy) in the event of risk factors identified on the surgical specimen.
2. Radiotherapy: external or brachytherapy
Radiotherapy uses rays to destroy cancer cells. It can be delivered in two ways: by external irradiation, over several sessions spread over several weeks, or by brachytherapy, which consists of directly implanting small radioactive grains inside the prostate. In more advanced forms, radiotherapy is often combined with hormonal therapy, over a period of 6 to 36 months depending on the level of risk.
| Processing | Principle | Typical patient profile |
|---|---|---|
| Total prostatectomy | Complete surgical removal of the prostate | Male under 70, localized cancer |
| External radiotherapy | Targeted irradiation over several weeks | Localized or locally advanced cancer, all age groups |
| Brachytherapy | Radioactive implants directly in the prostate | Localized low or intermediate risk cancer |
| Hormonotherapy | Testosterone suppression or blocking | Advanced forms, often associated with radiotherapy |
3. Hormone therapy: slowing down hormone-dependent cancer
Prostate cancer is a hormone-dependent cancer: its growth is stimulated by testosterone. Hormone therapy aims to reduce or block this hormone, thus slowing tumor progression. It is mainly used in advanced forms or as a complement to radiotherapy, rarely as an isolated treatment for localized forms. A notable development in recent years: the appearance of hormonal treatments administered orally, whereas this class of drugs previously required injections.
The side effects of hormonal therapy (fatigue, hot flashes, loss of muscle mass, mood disorders) are real and documented, which justifies, as mentioned in our article on physical activity, active support throughout the duration of treatment.
4. Other techniques, under evaluation or more targeted
Other approaches exist or are being evaluated, in particular for specific situations: high-intensity focused ultrasound (HIFU) and cryotherapy, which aim to destroy cancer cells using heat or cold in a more localized manner, or so-called "focal" treatments, which target only part of the prostate rather than the entire gland - a promising avenue for limiting side effects, but whose long-term follow-up remains, to date, more limited than for reference treatments.
⚠️ To remember on the medical level
The choice of treatment is always decided in a multidisciplinary consultation meeting, bringing together a urologist, oncologist and radiotherapist, then in discussion with the patient — never in isolation by a single practitioner.
Each treatment presents a different side effect profile (continence, sexuality, fatigue): these aspects must be addressed openly during the choice therapeutic, a subject that we will develop in the next article.
It is always legitimate to seek a second medical opinion before embarking on treatment, particularly for forms with intermediate risk where several options are valid.
Tips to remember:
- ●There is no universally “best” treatment for prostate cancer: the choice depends on the stage, Gleason score, age and patient preferences.
- ●Robot-assisted prostatectomy is gradually becoming more widespread in France, offering increased precision compared to older surgical techniques.
- ●Hormonal treatments administered orally now exist, whereas this class of drugs previously required regular injections.
- ●“Focal” treatments, which target only part of the prostate, are a promising avenue for limiting side effects, but with still limited follow-up compared to standard treatments.
- ●The therapeutic choice is always decided in multidisciplinary consultation: never hesitate to ask for a second opinion, particularly for forms with intermediate risk.
