It is estimated that in 2024 more than 30,000 people in Spain will receive the bitter news that they suffer from prostate cancer. Its diagnosis and treatment pose multiple pros and cons, so having a group of professionals who are a reference and updated on the latest advances in oncological treatment is crucial in decision-making. The Institut de Salut Prostàtica, ISPRO, has a group of urologists specialized in men's health, specifically in prostate diseases.
If we have a tumor marker that is measured in blood, why do we still need to perform a biopsy?
PSA is the tumor marker that helps us diagnose early-stage prostate tumors, but it can be elevated for other reasons, such as infections or the natural growth of the prostate. Prostatic MRI allows localization and definition of the degree of suspicious lesions, but biopsy is still necessary to confirm them. Biopsy using fusion systems allows precise confirmation of the location of the disease and also subsequent treatment.
How can prostate cancer treatment affect a man's quality of life?
The vast majority of tumors detected in the prostate are in their initial phase, therefore, acting directly on the prostate can guarantee the eradication of the disease. Until recently, the only known alternative was treatment of the entire prostate, either through robotic surgery or radiation therapy. However, today we already have selective treatment methods that act only on the malignant lesion. Focal Therapy focuses on treating only the area affected by cancer within the prostate, rather than subjecting the entire organ to more invasive treatments. With a procedure and anesthesia very similar to a prostate biopsy, more healthy prostate tissue is preserved, leading to fewer side effects and a faster recovery. The benefits of Focal Therapy include the preservation of sexual function and urinary continence, as well as allowing the patient to return to daily activity almost immediately.
How do you know which part to treat and which not to touch?
The procedure is carried out after the detection of the tumor by biopsy by fusion of MRI images and live ultrasound. The professional is able to see, through MRI, a suspicious lesion and confirm, through prostate biopsy, that the tumor is found only in said lesion. This is possible thanks to transperineal image fusion biopsies in which samples of the gland are taken through the perineum. These biopsies are more precise and have almost zero risk of infections, unlike the method through the rectum that was done in the past. With the confirmation and delimitation of the area with disease and, mainly, that the tissues outside the lesion are normal, it is possible to treat only part of the prostate, avoiding all the effects generated by the total removal of the gland.
How does Focal Therapy kill malignant cells?
Being able to locate the diseased area and reach it precisely without affecting nearby healthy tissue, the prostate cancer urologist must determine if the type of tumor is susceptible to this minimally invasive treatment. Ensuring oncological safety is a priority when choosing cancer treatment, therefore, Focal Therapy can only be performed in selected cases. In addition, there are different energies to destroy malignant cells. The decision of what energy to use for this purpose is based on the location of the lesion, size, proximity to other structures and characteristics of the patient themselves. Among the focal therapy possibilities that we offer at ISPRO we highlight Irreversible Electroporation (IRE), HIFU (High-Intensity Focused Ultrasound), cryotherapy and FLA (Focal Laser Ablation).
What advice would you give to someone considering Focal Therapy for prostate cancer?
Our advice would be to seek the opinion of a urologist specializing in prostate cancer and Focal Therapy to discuss all available treatment options and determine the best option for your specific situation. On some occasions we find patients who seek focal treatment, but after evaluation we identify that their case is not suitable for this technique. The Da Vinci robotic surgery that we have offered for many years has presented very good results and continues to play an important role in the treatment of these people. It is also important that they fully understand the possible benefits and risks associated with therapeutic alternatives and that they make an informed decision together with their families.
Is it possible to apply this treatment in cases of urination problems?
In patients with benign prostatic hyperplasia, but without prostate cancer, there are various minimally invasive treatments, but in this case we can apply them through the natural opening of the urethra. There are therapies such as REZUM or Aquablation that allow ejaculation to be maintained, but prostate enucleation with Holmium Laser (HoLEP) offers the best alternative with a rapid recovery and an improvement in symptoms in the very long term.
