Observation
- What does it consist of? Periodic controls with analytical and symptom control without any active treatment.
- To whom is this indicated? Patients with a localized PdA and a life expectancy of less than 10 years.
Prostate cancer treatment
There are many types of approaches and treatments for the diagnosis of a localized Prostate cancer (PCA) depending on its stage and risk group. But in all of them the decision has to be agreed with the patient and evaluated by a multidisciplinary medical team according to the guidelines set out in the international guidelines.
Treatment modalities of prostate cancer
The modalities currently described are:
Surgery - Radical Prostatectomy (Open, Laparoscopic or Robotic)
- What does it consist of? Surgical removal of the prostate gland and seminal vesicles by surgery and reconstruction of the urinary tract. Classically, the sequelae of open surgery were a high rate of urinary incontinence and erectile dysfunction. With the robotic platform, these complication rates have improved a lot but there is still a percentage of patients who can present them.
- To whom is this indicated? Patients with a life expectancy greater than 10 years and with a localized PdA categorized as low risk (and they want to be treated directly), intermediate risk or high risk according to the guidelines. In the latter two groups, a removal of the pelvic lymph nodes can be added in the same act.
External radiation therapy +/- hormonal therapy
- What does it consist of? External irradiation of the prostate gland and seminal vesicles with a therapeutic dose divided into several daily sessions lasting approximately 3-6 weeks depending on the stage, risk and type of accelerators. Efficacy comparable to surgery with similar side effects in the urinary and sexual sphere. Severe toxicity is less than 5%.
- To whom is this indicated? Same indications as in surgery. In cases of intermediate and high risk, hormone therapy is indicated (between 6-36 months). And in high-risk patients, irradiation of the pelvic nodes is also indicated.
Brachytherapy
- What does it consist of? Internal irradiation of the prostate gland with permanent or non-permanent implants.
- To whom is it indicated? Patients with a life expectancy greater than 10 years and with a localized PdA categorized as low risk, who do not want to undergo the other therapeutic alternatives.
Other treatments - Focal therapy (Experimental)
Cryotherapy
- What does it consist of? Transperineal application of cryoinjets applying two freezing cycles. The technique can be used on the whole gland or on part of it (focal therapy).
- To whom is it indicated? Patients with a life expectancy greater than 10 years and a localized PdA categorized as low/intermediate risk, a prostate smaller than 40 cc and no urinary symptoms.
HIFU
- What does it consist of? Transrectal application of ultrasonic waves that treat the prostate by means of heat (65ºC). The technique can be used on the whole gland or on part of it (focal therapy).
- To whom is it indicated? Patients with a localized PdA categorized as low/intermediate risk, with a life expectancy greater than 10 years and always in the experimental setting.
