Prostate cancer treatment

There are many types of approaches and treatments after the diagnosis of localized prostate cancer (PCa) depending on its stage and risk group. But in all of them the decision has to be made with the patient and evaluated by a multidisciplinary medical team according to the international guidelines.

The approaches currently described are:

A) Watchful Waiting:

1. 1. . What about it? – Periodic controls with blood tests and control of symptoms without any active treatment.
  2. What are the indications? – Patients with localized PCa and a life expectancy of less than 10 years.

B) Active Surveillance:

1. What about it? – Periodic controls every 6 months with blood tests (PSA) and/or Prostate Ressonance, and prostate biopsies every 12-24 months, without any active treatment. In the event that there is an evolution of the aggressiveness of the tumor in the biopsies, it is decided to perform an active treatment. If not, it remains under active surveillance.
2. What are the indications? – Patients with a life expectancy greater than 10 years, with a localized PCa categorized as low risk according to the guidelines, who do not want to initially undergo active treatment or want to defer it for a time to postpone the possible complications of the other treatments.

C) Surgery – Radical Prostatectomy (open, laparoscopic or robotic):

1. What about it? – Surgical removal of the prostate gland and seminal vesicles by surgery and reconstruction of the urinary tract. Classically, the sequelae of open surgery were high tax 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.
2. What are the indications?– Patients with a life expectancy greater than 10 years, with localized PCa categorized as low risk (and want to treat directly), intermediate risk or high risk according to the guidelines. In these last two groups, a removal of the pelvic lymph nodes could be needed.

D) External radiotherapy +/- hormone therapy:

What about it? – External irradiation of the prostate gland and seminal vesicles with a therapeutic dose divided into several daily sessions with an approximate duration of 3-6 weeks depending on the stage, group risk and type of accelerators. Efficacy is comparable to surgery with similar side effects in the urinary and sexual sphere. Severe toxicity is less than 5%.
What are the indications? – 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.

E) Braquiterapia:

1. 1. What about it? – Internal irradiation of the prostate gland with permanent or non-permanent implants.
  2. What are the indications? – Patients with a life expectancy greater than 10 years, with localized PCa, categorized as low risk, who do not want to undergo other therapeutic alternatives.

F) Other treatments/Focal therapy (Experimental)

- Cryotherapy:

1. 1. What about it? – Transperineal application of cryoneedles that apply two freezing cycles. The technique can be used on the entire gland or on part of it (focal therapy)
  2. What are the indications? – Patients with a life expectancy greater than 10 years, with localized PCa categorized as low/intermediate risk, prostate less than 40cc and without urinary symptoms.

HIFU:
1. What about it? – Transrectal application of ultrasonic waves that treats the prostate by means of heat (65ºC). The technique can be used on the entire gland or on part of it (focal therapy)
2. What are the indications? – Patients with a life expectancy greater than 10 years, with localized PCa categorized as low/intermediate risk, and always in the experimental setting.

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Prostate cancer treatment

AndrologiaMallorca