The way we treat prostate cancer has changed dramatically in recent years. Advances in MRI imaging have undoubtedly contributed to this change, both in terms of diagnosis — by making targeted biopsies possible — and in terms of our approach to treatment. The emergence of new treatments (next-generation hormone therapy, radionuclide therapy, etc) has also improved the prognosis of patients with metastatic cancer.

For an update on these advances, Medscape interviewed Guillaume Ploussard, MD, a urologist and oncologist at La Croix du Sud Clinic, Toulouse, France, and head of the French Urology Association’s (AFU) prostate cancer subcommittee.

Medscape French Edition: The way we treat prostate cancer has changed dramatically in terms of diagnosis and therapeutic approach. In your opinion, what has been the most significant step forward in recent years?

Guillaume Ploussard, MD: The move towards personalized treatment options. Thanks to an improvement in imaging techniques and the contribution made by genomics, we can now better categorize a specific case of cancer, foresee how it will evolve, and adapt our therapeutic approach accordingly for each individual patient.

Our ability to obtain more precise MRI images, along with improvements made in training radiologists to interpret these images, has made us better at detecting prostate cancer. These advances in MRI mean we can identify the most severe cancer cases, which, in turn, stops us from starting treatment in patients who don’t need it.

In terms of genetic testing, we are now better at determining an individual’s risk and treating patients with greater accuracy. Such testing is used, in particular, to characterize tumors and justify the use of certain treatments, such as poly-ADP ribose polymerase (PARP) inhibitors for metastatic cancers.

Medscape: Oncogenetics has also gathered pace in preventing prostate cancer. How has this affected the treatment you provide?

Ploussard: There has been a growing awareness both in patients and in doctors of the role played by genetics in the risk of developing prostate cancer. It is estimated that less than 5% of cases of prostate cancer are linked to genetic mutations. Nearly 4 years ago, consultation with an oncogenetic specialist was added to the treatment protocol. Patients with a family history of prostate cancer are advised to undergo testing for the following gene mutations: BRCA1, BRCA2, and HOXB13, which are associated with an increased risk of developing an aggressive form of this type of cancer.