Early diagnosis and individualised treatment of prostate cancer: FOCALYX®
Prostate carcinoma is the most common tumour in men in the United States and the European Union is second only to lung cancer. Its incidence has increased in recent years. Its incidence increases with age, especially after 50 years. Its early diagnosis can be made via the determination of PSA (prostate-specific antigen), digital rectal examination and prostate biopsy. Technological developments have allowed the incorporation of diagnostic techniques such as Magnetic Multiparametric Resonance and Fusion, allowing an advance in the early diagnosis of prostate cancer.
The treatment depends on the extension of the disease but in most cases, we can offer a therapy with curative intent. Its functional results should be assessed in order to preserve the patient’s quality of life (urinary continence and sexual function) to maintain oncological security. In our CUMQ-Lyx Centre for Urology, we value the quality of life of our patients, betting on an individualised treatment plan and directed, contemplating the Active Surveillance and Focal therapy according to the case.
We offer the following diagnostic strategies and therapeutic alternatives:
- Detailed assessment in each case, taking into account family history, PSA and digital rectal examination, as well as any previous data from the patient
- Individualised indication, if necessary, of Transrectal Ultrasound with multiple biopsies (high resolution) and under sedation (USDS)
- Diagnostic studies and extension of last generation:
- Multiparametric Magnetic Resonance Imaging
- With helical CT “3D” reconstruction
- Positron emission tomography (PET/CT/PET PET-Colina)
- Bone scan, and selective radiology
- Expert anatomical-pathologic assessment
- Study and calculation of individual risk based on nomograms and Prediction Tables
- Biochemical and molecular markers of the risk of CP (4kscore, PROLARIS)
Treatment options available in our centre, to be defined and identified in each case:
- Active surveillance
- Focal therapy of prostate cancer
- Robotic radical prostatectomy (da Vinci) with preservation of neurovascular bundle, in selected cases.
- Laparoscopic radical prostatectomy with preservation of neurovascular bundle, in selected cases.
- Open retropubic radical prostatectomy with preservation of neurovascular bundle, in selected cases.
- “3D” external conformal radiation therapy
- Prostate brachytherapy
- Hormotherapy: In cases of tumour spread. New guidelines to minimise the impact on quality of life (Intermittent and Sequential Androgenic Block)
- Controlled observation in selected cases.
- Early sexual and urinary rehabilitation thanks to new treatment strategies (PDE5 inhibitors, intracavernosal injections, exercises and perineal rehabilitation, electrostimulation, etc.)
- Strict monitoring of the patient with the goal of reaching the “Trifecta” status (absence of tumour after surgery, urinary and erectile function identical to before treatment)
What is prostate cancer?
Prostate cancer is a disease that affects the cells of the prostate. Normally, cells grow and divide in an organized manner. This is the way that the body grows and remains healthy. Sometimes, the normal process of cell growth can fail. If cells keep dividing when they shouldn’t, they can form a tumour. Prostate cancer is at first confined to the prostate, but it can continue to grow and spread to other parts of the body. Prostate cancer is the most common cancer among men. It is the second leading cause of cancer death among men. However, because of the slow growth that characterizes this tumour, most patients with prostate cancer do not die from this disease.
A localized prostate cancer usually doesn’t cause discomfort or symptoms.
Generally, prostate cancer that is confined within the gland does not cause symptoms. For this reason, early detection is very important.
Once diagnosed with prostate cancer, different options can be offered for treatment. Each of them has its risks and benefits.
Prostate cancer: tools used for early detection
The objective of early detection of prostate cancer is to find the disease in its early stages when the majority of treatments are more effective. Hence, the following will be performed:
- Determination of Prostate Specific Antigen (PSA): this test is performed by taking a blood sample. PSA is a protein normally found in the blood at very low levels. High rates may indicate prostate cancer.
- Digital rectal examination (DRE): DRE consists in feeling the prostate by introducing a finger in the perineum. The information that your doctor can determine by touching the prostate are important to rule out the presence of prostate cancer. This method is both safe and simple.
The most accurate method for detecting prostate cancer is by performing two tests both the PSA and DRE. While the PSA detects most of the aggressive tumours, some tumours do not raise the antigen and their detection depends on digital rectal exam alone. Therefore, using both tests will give us more information.
Who is at risk of prostate cancer?
The American Urological Association established that periodic tests need to be carried out to rule out prostate cancer for all male patient whose life expectancy is greater than 10 years and who are:
- Over 50 years of age
- Over 40 years of age and have a family history of prostate cancer
Submitting yourself to an examination in search of prostate cancer is a decision that should be taken both by you and your doctor. You must be aware of the advantages and disadvantages of early detection and treatment. You need to be aware of the following additional information:
People with a life expectancy of less than 10 years have little benefit in early detection and treatment.
The treatment of prostate cancer involves a certain risk of impotence (inability to achieve an erection) and incontinence (inability to control the flow of urine).
How will my doctor diagnose prostate cancer?
Although the high rate of the prostate-specific antigen or an abnormal digital rectal examination may suggest the presence of prostate cancer, the only way to confirm the diagnosis is by realising of a prostate biopsy. A biopsy is a procedure by which a small piece of tissue for analysis by a pathologist.
Collecting biopsies is a minimally invasive procedure (USDS). It involves collecting a small amount of prostate tissue by introducing a special needle through the rectum. An ultrasound transducer and magnetic resonance imaging (FOCALYX Dx) are used to guide the needle. This procedure is usually performed with same-day surgery and local anaesthesia only. If you wish more information, you can visit the page on biopsy-fusion with Focalyx Bx.
What should I expect after the biopsy?
After the biopsy, there may be certain effects such as infections or bleeding from the rectum or urine. Serious complications are rare. Blood in the stool and urine usually disappears after a few days, while the blood in the semen takes a few weeks to disappear. When we indicate the performance of the biopsy, you will be given the relevant information with regard to the antibiotics and care for this procedure. It is important that you indicate whether you are taking aspirin or any other medicine to prevent blood clotting. In conjunction with the doctor who prescribed this medication, we will decide whether it is appropriate to suspend it before the biopsy. Do not stop taking any medicine unless we tell you otherwise. It is also important to mention if you have any prosthesis in any part of the body (heart valve, hip prostheses, etc.), since this can require a special antibiotic management.
What should I do if I am diagnosed with prostate cancer?
If you are diagnosed with prostate cancer, there are a number of studies we should perform to determine whether the tumour has spread. This is known as a “study of extension”. Not all cases require a study of extension. The tests will be requested according to your PSA and the features that the pathologist will report in their biopsy:
- Computerized Axial Tomography (CAT scan)
- Magnetic resonance imaging (MRI)
- Bone scan
Treatment of localised prostate cancer
There are now several therapeutic options for managing prostate cancer, including “watchful waiting” or active surveillance, focal therapy, surgery, radiation therapy and hormone therapy. In some cases, you may need more than one form of treatment. The goal is to decide the method that best fits your situation and needs.
- Active surveillance: it may be an option for patients with slow-growing tumours that is diagnosed in very early stages. Basically, the decision is made not to initiate any treatment and to perform a very close monitoring to determine the rate of tumour growth. Studies will show us whether treatment is required and when to initiate an active treatment.
- Focal therapy: localised low-risk tumours can benefit from a treatment focused on the area where the tumour is located in the prostate gland. Among its advantages, reduced side effects, hence a lighter impact on quality of life. On the other hand, such treatment may require along with the follow-up, a new intervention with focal or radical therapy. For more information, visit the website of focal therapy with Focalyx Tx.
- Surgery: the surgical procedure that aims to eliminate the whole prostate gland and surrounding tissues is called radical prostatectomy. It is performed under general anaesthesia and recommended if the tumour is located in the prostate, i.e. when found in early stages. After removal, the prostate is analysed by a pathologist. If the tumour was indeed located in the prostate and the latter is removed in its entirety, the risk of death from prostate cancer is very low. The disadvantage of surgery is the risk of complications such as impotence and incontinence. To decrease the number of complications, in selected cases, neurovascular bundles can be preserved. The surgical access in the case of radical prostatectomy are multiple. In our LYX Centre for Urology CUMQ, we have a team of professionals with extensive experience in all its variants, which include: open, laparoscopic and robot-assisted surgery (da Vinci).
- Radiation therapy: the objective of radiation therapy is to destroy the cells targeted by the radiation therapist. It can be used instead of surgery, or after surgery, to destroy the cells that may remain. Forms of radiation therapy:
- External radiation therapy: treats the prostate with a carefully focused beam of radiation to the prostate. In general terms, it is well tolerated by patients and the side effects vary and include inflammation of the rectum and bladder as well as impotence. In most cases the side effects are mild to moderate. Hospitalisation is not required and the patient receives treatment once a day, 5 days a week, during 6 to 8 weeks.
- Brachytherapy: placing radioactive “seeds” inside the prostate. This procedure is performed under general anaesthesia, although it may be performed on an same-day surgery basis.
Monitoring and follow-up care
Once you have received some treatment for prostate cancer, it is important to carry out regular monitoring for recurrent disease. Monitoring shall be carried out every 6 months.