Cancers de la prostate

There are no symptoms specific to prostate cancer. However, it can sometimes manifest itself through the following clinical signs: more frequent urination (especially at night) and difficulty urinating (delayed urination, weak stream, pain or burning during urination, feeling of incomplete emptying). These symptoms are not necessarily permanent but are more often fluctuating and vary in intensity.

In most cases, the cancer is discovered by chance during a PSA (prostate-specific antigen) test or a digital rectal exam without any prior symptoms.

For prostate cancer, the CFB offers several types of treatment depending on the patient's clinical situation:

External radiotherapy

This treatment uses X-rays directed through the skin to the area to be treated. These rays are produced by a linear accelerator and gradually destroy the cancer cells.

Your treatment will begin with a scanning session (called virtual simulation) to identify the areas to be treated (target volumes) and the healthy organs around them that must be preserved as much as possible.

Your treatment plan will be tailored to your individual needs (taking into account your specific characteristics and those of your disease) and scheduled over several weeks. Sessions take place from Monday to Friday and last approximately 15 minutes.

The radiation is invisible and painless and does not make you radioactive.

Your doctor will give you some instructions to follow carefully to ensure the treatment is effective.

Stereotactic radiotherapy (Cyberknife)

Stereotactic body radiation therapy (SBRT) delivers high doses to very small areas with millimeter precision. This type of treatment is offered to certain patients based on specific criteria; it requires the implantation of gold seeds, called fiducials, which help to better locate the tumor during treatment.

The fiducials are inserted transcutaneously (through the skin) in the perineal area. They are permanent implants that have no effect during or after treatment.

Brachytherapy

Brachytherapy for the prostate involves placing radioactive iodine seeds in the prostate. The iodine seeds are encased in a titanium capsule and do not cause allergies. They work by emitting radiation over a few millimeters.

The radiation emitted away from the prostate and at the surface of the body is harmless (it is lower than natural radiation, such as that received during a stay in the mountains or a plane trip).

This radioactivity decreases with time and distance. However, there are precautions to be taken after the radioactive seeds are implanted (in particular, limiting close contact with children, pregnant women, and pets). 

Prostate brachytherapy requires a short hospital stay of 3 days.

Hormone therapy

The aim of this treatment is to suppress the production or action of male hormones that promote the growth of cancer cells. Suppressing this hormonal stimulus slows the progression of the cancer and reduces the size of the prostate tumor. These treatments can be administered in the form of tablets and/or subcutaneous or intramuscular injections. They are necessary in combination with radiation therapy for certain stages of the disease.

Side effects are predictable but not systematic in radiotherapy treatment; each situation is unique and each patient reacts differently. We encourage patients to report any adverse effects to their referring physician at the CFB during weekly follow-up consultations. Nowadays, the most common acute side effects are very well managed with symptomatic treatments. These will be prescribed by your radiation oncologist if necessary.

During radiotherapy

• Fatigue: Fatigue is a common side effect but is not necessarily caused by the treatment. It is often due to the daily repetition of the treatment. It is also sometimes a side effect of the previous surgery or hormone therapy.
• Urinary problems: Increased frequency of urination, especially at night, difficulty urinating with a need to strain, burning during urination, or urgent need to urinate with a strong urge to go.
• Digestive problems: Diarrhea (or sometimes constipation), false urges or rectal pain.
• Sexual disorders: Erectile dysfunction and loss of libido, particularly if hormone therapy is prescribed at the same time.

During brachytherapy

• Urinary problems: A burning sensation when urinating may occur in the days following the procedure. This will subside within a few months. Other side effects may occur, such as frequent urge to urinate and/or weak urine flow. These symptoms also gradually subside, but may sometimes last for a few months.
• Digestive problems: Digestive problems are related to inflammation of the rectum (rectitis) and may appear temporarily (more frequent urge to have a bowel movement, burning). Blood in the stool is possible (but rare) after brachytherapy, due to the fragility of the rectal mucosa.
• Migration of one or more seeds: One or more seeds may migrate into the urine, semen, or bloodstream. Condom use and urine filtration are recommended for two weeks after the procedure.
• Fertility and sexuality: Brachytherapy of the prostate causes a change and reduction in the volume of ejaculate. Fertility may be reduced. Sexual problems, including impotence, may occur. This impotence may develop over a period of several months or even years. It depends on the patient's sexual activity prior to the procedure and his age. A small amount of blood in the semen is possible for a few weeks. The semen may be black or brown in color, but this is not serious.

The radiation continues to affect the body after the end of treatment. Fatigue and side effects often persist for some time. We invite you to discuss your symptoms during your post-treatment follow-up at the CFB.

• Urinary problems: These include difficulty urinating with the need for medication to facilitate urination, increased frequency of urination, or traces of blood in the urine.
• Digestive problems: In rare cases, blood in the stool may require specialized care.
• Sexual disorders: Some patients continue to experience erectile dysfunction, which can be treated by a specialist.