Surgery and radiotherapy are the two alternatives in the treatment of prostate cancer
iTAcC’s physicians will be in contact your urologist for creating a personalized treatment based on a multidisciplinary approach
The prostate is a male gland whose primary function is to produce and store seminal fluid released during ejaculation. It is located next to the rectum, below the bladder and surrounding the urethra.
Prostate cancer is one of the most common among men. The incidence is directly related to age: at the age of 50 approximately 1 in 4 men have prostate tumor cells and at the age of 80 the disease affects 1 in 2 males.
An enlargement of the gland does not necessarily indicate the presence of a tumor and it may be only a benign hypertrophy of the prostate.
Prostate cancer usually grows slowly. Although the cause is not yet clear it seems that the origin is a mutation in the DNA of some prostate cells that causes abnormal proliferation leading to a tumor.
A greater incidence of prostate cancer has been seen from the age of 65 and in black men. Diets rich in saturated fats, obesity and a family history of prostate cancer also appear to have influence.
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The only way of preventing this type of cancer is keeping weight under control and limiting the intake of fats, especially saturated ones such as animal fat as well as some types of cheese. An early diagnosis is obtained by a clinical examination. The prostate-specific antigen (PSA) is measured with a simple blood test which should be done regularly after 50 as a rule and after 40 if a family history exists.
The early stages of prostate cancer are usually asymptomatic. Approximately 30% of cases are discovered when the disease has already spread beyond the gland.
Screening tests are often part of a routine medical examination, especially in men over 40 years old. The doctor may also recommend special testing because of symptoms suggestive of a prostate disorder. Testing includes:
- Rectal examination. Approximately 70% of the tumors develop in the peripheral region of the prostate and in some cases are detectable through a rectal examination.
- Blood testing by analysis of the PSA number (Prostate Specific Antigen). Elevated PSA levels may indicate prostatic hypertrophy, prostatitis and prostate cancer.
- Biopsy – a trans-rectal prostate biopsy under local anesthesia and guided by ultrasound should be done when your physician deems it necessary in order to confirm a clinical suspicion (palpation) or biochemical (elevated PSA). The examination consists of taking a variable number of small tissue samples from different areas of the prostate. The tissue is examined under a microscope for the presence of neoplastic cells. The biopsy is done as an outpatient procedure and usually does not require hospitalization.
The study must be completed with additional testing if the result of the biopsy was positive for prostate cancer.
- Chest x-ray – this should be done even although less than 5% of prostate cancers may spread to the lungs.
- Computed Tomography (CT) - The CAT is mainly useful in combination with other tests. The pathological lymph nodes in the pelvis and abdomen where prostate cancer can spread are seen.
- Magnetic imaging (MRI) scan - MRI does not require the use of radiation. Until now it is used in specific cases to evaluate the possible extension of the tumor to the pelvic lymph nodes.
- Bone scan is a diagnostic procedure useful in determining the spread of cancer to the bones. Its necessity depends on the type and stage of prostate cancer as well as the PSA values.
- Choline PET scan. It is a modern method that uses a specific radiopharmaceutical. Currently it is the exam with the highest diagnostic accuracy for evaluating the spread of the disease particularly if a revaluation is necessary in the case of a biochemical recurrence.
Treatment options are recommended by the physician once the diagnosis of prostate cancer has been confirmed, its aggressiveness classified according to the Gleason grading system and its extension evaluated. These options range from observation with active surveillance, surgery or radiation therapy and associated or not with hormone therapy. The use of chemotherapy may also be indicated when the cancer is more advanced. Treatment choice depends on factors such as the Gleason grade of the tumor, PSA level, and tumor size, its spread outside the prostate, the patient's age and overall health.
iTAcC’s medical team has extensive experience and evaluates a large number of people affected by prostate cancer each year. This experience helps to determine which the most appropriate therapy is for each patient using a multidisciplinary approach as well as the possible use of different treatment modalities. iTAcC physicians are in contact with your urologist for creating a personalized treatment in each case based on a multidisciplinary approach.
Surgery and radiotherapy are the two major alternatives in the treatment of prostate cancer.
It is based on the radical prostatectomy (removal of the gland) which can be performed in different manners: open or laparoscopic, with or without lymphadenectomy (removal of lymph nodes) along with preservation of the nerves and muscles that regulate sexual function and urination.
External radiation therapy
It involves administration of radiation to the prostate destroying the tumor cells which are more susceptible to the damaging effects of radiation than normal cells. Radiation can be used to treat almost all stages of prostate cancer, with or without surgery. This depends on the overall health of the patient and the severity of tumor. Advances in the field of radiation therapy in the last decade have allowed for treatments to be done with very low incidence of side effects. These treatments are called intensity modulated radiation therapy (IMRT) and image-guided radiotherapy (IGRT). iTAcC’s team of specialists has treated more than 3,000 patients employing these techniques and is a pioneering team in their implementation in the European Union. It is iTAcC’s proposal to use the state of the art radiotherapy treatment of prostate tumors called volumetric modulated Arc therapy (VMAT).
It involves the administration of drugs that reduce the production of male sex hormones, responsible for accelerating the growth of prostate cancer. By itself or in combination with other therapies, it represents a choice in cases of advanced prostate cancer.
It is used in patients who develop a resistance to hormone therapy.
Observation and active surveillance
Patient follow up consists of a periodic evaluation of PSA levels and occasional repeated biopsies and may represent a therapeutic option in selected cases.
In iTAcC it has the means to monitor and control the progress of patients who have had prostate cancer in order to rule out the possibility of disease recurrence.
At iTAcC a follow up is done as all oncological activity at our center in a personalized manner with the cooperation of physicians who have been involved in the diagnosis and treatment of each case.