Prostate cancer: a dedicated Institute in Reims

Operation Movember reminded us that prostate cancer still claims too many lives. The Prostate Institute of the University Hospital of Reims, unique in France, has made it its hobbyhorse. Meeting with Prof. Stéphane Larré, head of the urology department at the CHU de Reims and head of the Institute.

How did you come up with the idea of ​​creating the Prostate Institute and what is its purpose?
Stephane Larre:
I practiced for several years in Oxford, in the United Kingdom, and I saw how useful it was to bring together* know-how to carry out faster diagnoses and therefore more effective treatments. The Institute was officially created in 2019, but we had already started to work in this way by creating a synergy of skills in the same place where patients can meet surgeons, radiotherapists, perform MRIs, biopsies… More again, they are accompanied by personnel who have a certain “savoir-être”. Announcing the disease, explaining the options, letting the patient choose, surrounding him… this is also part of the treatment.

Concretely, how do you operate?
S. L. :
We receive patients referred by their GP by mail. I look at all requests and, depending on the case, I give deadlines for appointments. The patients then see all the professionals quickly thanks to the appointments that we organize ourselves. In the specific case of prostate cancer, “waiting” a month is not dramatic, because the latter progresses slowly. But for the patient who wants a diagnosis, to have an answer in one or two weeks without having to run between practitioners, this represents a real difference. We have acquired this know-how over the years and 9 out of 10 patients feel… I am not going to say happy, of course, but at least reassured after their diagnosis.

Do you see the number of patients increasing since the creation of the Institute?
S. L. :
Everything was disrupted because of the Covid. But we know that our organization has made it possible to increase patient care. Still, access to operating theaters is not always easy to obtain. Our team actually covers an entire territory, so we often transfer operations such as prostate adenomas or kidney stones to other nearby hospitals, such as Épernay for example. What also makes us waste a lot of time is that, unlike other countries, our nurses cannot perform a prostate biopsy, which is a very systematic procedure. However, some, once trained, would be quite capable of it. There, the legislature does not help us. Advanced practice nurses (IPA) work more on long-term support. A solution should be found.

Expansion plans?
S. L. :
We have already begun to look into an important subject: hematuria (presence of blood in the urine) which is often a precursor to kidney or bladder cancer. For example, 20% of them in patients over 50 are due to cancer. However, especially for that of the bladder, the time factor is crucial. We are therefore going to launch SOS haematuria, a clinic dedicated to this subject, so that each patient with blood in the urine knows where to go as soon as possible so that a check-up can be carried out.

* The Institute currently has three urologists, two radiotherapists, an oncologist, a referring radiologist, a referring pathologist and a coordinating nurse.

Interview by Sophie Caux-Lourié

Professor Stéphane Larré