Prostate cancer (PCa) is a very common pathology, which affects up to 25% of men over 50 years old and 80% of those over 80.
The cause is unknown, but there is likely a relationship with hormones, age, race, and it has a clear genetic component since, if a first-degree relative (parent or siblings) has it, the risk of suffering from it increases.
At Urología Tratamiento we have a multidisciplinary team dedicated to PCa comprising professionals with extensive experience and prestige in this field.
Our team consists not only of urologists, but of uro-pathologists, uro-radiologists, oncologists and radiotherapists, all focused on the diagnosis and treatment of PCa.
We also work in a centre equipped with the highest level technology, to be able to diagnose and stratify the disease and design a personalised treatment:
- Multiparametric magnetic resonance.
- Fusion biopsy.
- Helical CT with “3D” reconstruction
- Skeletal scintigraphy.
- Positron Emission Tomography (PET/PET-CT/Choline PET).
- Biochemical and molecular tumour markers of PCa.
Screening for prostate cancer is first performed through a digital exam (digital rectal examination), and shall be complemented with a blood test to measure the PSA. It is possible to detect the disease before suffering the symptoms. Today, there is new diagnostic tests available that facilitate this task: proPSA, 4-Kallikrein, PCA3.
After a general physical exam, your doctor will ask you some questions about your symptoms and medical background, and will perform some of the following tests:
» Digital rectal exam (digital rectal examination):
During the test the doctor inserts a finger into the patient’s rectum to detect any hard, irregular areas in the prostate (swelling or protuberance) which could indicate cancer.
» Blood test:
Consists in determining the blood levels of prostate-specific antigen (PSA), a protein produced by the prostate and that can be raised in a number of situations, including PCa.
» Urine test:
A urine sample is taken to determine whether there is blood or other abnormalities, such as bacteria or inflammatory cells that could lead to an infection. It is also necessary to determine some cancer markers.
» Transrectal ultrasound (TRUS):
This technique provides a more accurate image of the prostate than traditional ultrasound. An ultrasound probe is introduced in the patient’s rectum. It is performed on an outpatient basis and lasts about 10 minutes.
It enables evaluating the shape and size of the prostate. It is also helpful while collecting biopsies. Performance for tumour detection through imaging is low.
» Prostate biopsy:
The only way to confirm the diagnosis of prostate cancer is by taking a tissue sample (biopsy).
The biopsy consists of inserting a needle into the prostate with the intention of extracting some of this tissue and analysing it. This test allows confirmation of the disease, although a negative result does not completely rule it out.
» Fusion prostate biopsy:
Given the scarce information offered by the transrectal ultrasound, nowadays it has been established that a multiparametric magnetic resonance shall be carried out before the first biopsy, which will show whether there are any suspected PCa areas.
With the MR image in the operating room, thanks to a complex computer system, the images of the MR are merged with those obtained at that time with the ultrasound, allowing us to direct the biopsies to the suspicious areas of the prostate.
The information obtained is much more comprehensive and will allow a personalised treatment of the patient (see specific section for more information).
In many cases, prostate cancer treatment is administered over a long period of time, since this type of cancer usually progresses very slowly.
PCa treatment will depend mainly on the phase of the disease, as well as the aggressiveness of the tumour considering the patient’s clinical profiling.
Thus, there are several treatment modalities for prostate cancer:
» Active monitoring:
Since there are non-aggressive tumours, selected patients may not be treated, closely monitoring the tumour. Treatment is only administered upon detection of increased cancer aggressiveness.
This operation consists of the complete removal of the prostate gland and surrounding tissues. In some cases, the lymph nodes of the pelvic area are also extracted.
It can be carried out through various approaches: open, laparoscopic or robotic. None of these options have been shown to be superior to the others in terms of cancer control, or preservation of the patient’s urinary or sexual function, although laparoscopic and robotic surgery have been shown to decrease patient bleeding and reduce hospital stay.
It can be administered as a mono-treatment or in combination with surgery. May be carried out through brachytherapy by implanting radioactive seeds into the prostate gland or externally (applying radiation through machines).
» Hormone therapy:
Testosterone, a male sexual hormone, is directly connected to tumour evolution. Hormone treatment works reducing testosterone levels in the body or blocking its effects on the prostate.
» Focal therapy:
Used in localised, non-aggressive small tumours. Only the tumour area is treated, thus avoiding or diminishing the possible complications or side effects of other therapies (erectile dysfunction, incontinence).
There are various methods depending on the characteristics of the tumour to be treated: cryotherapy, HIFU or electroporation. It is essential to previously diagnose PCa with fusion biopsy (see specific section for more information).