Forty years ago, urologists were generally seeing prostate cancer patients referred by radiologists. The patients were admitted for bone pain because the cancer had metastasized.
The most common treatment was to remove the testicles, cutting the hormone testosterone that contributes to the cancer’s growth. American physician Charles Huggins discovered this link in the 1940s.
In a few cases, the cancer could be detected through rectal examination, before it had spread. These patients were then sent for radiation therapy.
This was the situation of the disease before the 1980s as described by Dr. Jacques Corcos, a French-trained urologist, who was honoured last month by Montreal’s West Island Prostate Cancer support group for his outstanding contribution in treating and researching the disease, and training residents. He teaches at McGill, is on staff at the Jewish General and MUHC hospitals, and is urology director at the Rehabilitation Institute of Montreal.
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In the mid-1980s, there was a shift in treatment, with less radiation therapy and more radical prostatectomy, the operation to remove the prostate gland and some of the surrounding tissue. Around 1990, the blood test to determine the PSA – Prostate-specific antigen, the protein produced exclusively by prostate cells – became common.
“Suddenly, many more people could be cured than in the past, and we saw fewer patients coming with metastasis,” he recalled.
Since then, there have been significant developments in biopsy techniques. One uses MRI (magnetic resonance imaging) to examine the prostate and nearby lymph nodes to distinguish between non-cancerous and malignant areas.
Corcos lobbied for more than $3 million to get robotic equipment for prostate cancer surgery at the Jewish General Hospital.
“It was supposed to evolve into real robotic surgery, where you put tubes in the belly and the robot does the work, removing the prostate, guided by sophisticated imaging,” he said.
Robotic equipment makes it easier for the surgeon to carry out the work, but “for the patient it doesn’t change much.”
“We made some progress in medication. There is a lot of research in Montreal, at Notre Dame Hospital, on medication that helps healing for bone metastasis. It prolongs patient survival. … To be really honest, we did not improve survival. But we improved quality of life for patients, with less pain and discomfort.
“Prostate cancer is extremely complicated, an extremely sophisticated enemy, which behaves completely differently from all other cancers. Everybody is different, and we have to individualize treatment.”
For now, scientists have “no clue” as to what might trigger the onset of prostate cancer, but research must continue, he said.
According to the Canadian Cancer Society, prostate cancer is the most common cancer among Canadian men (excluding non-melanoma skin cancers). It is the third leading cause of death from cancer in men in Canada.