Prostate cancer treatment

diagnóstico de cancer de prostata

The treatment of prostate cancer will depend on different factors: the type and stage of cancer, the patient’s general health, possible side effects, and the patient’s preference.
 
At HC Marbella, a multidisciplinary medical team of medical oncologists, urologists, surgeons and radiation oncologists will work together as a team to provide the treatment option that best suits the needs of each patient.
 
It is essential that the patient is well aware of the possible treatment options to decide, together with his team of specialists, which is the best treatment for him.
 

consulta con tu urólogo

When prostate cancer is diagnosed early and its growth is slow, treatment may lead to more risks than benefits. In these cases, active surveillance may be recommended.

 
Active surveillance consists of careful monitoring of your cancer. Depending on the patient and the type of tumour, this involves recommended periodic follow-up consultations. During consultations, PSA values and digital rectal examination will be carried out and, if necessary, imaging tests or biopsies may be requested. If the results change, your urologist may recommend starting treatment.
 
Active surveillance is recommended, depending on the age of the patient, when:

  • The tumour is small and located in the prostate.
  • Its growth is slow.
  • It is not causing any symptoms.
  • It is associated with low PSA levels (10ng/mL).

cirugia urologia

Surgery for prostate cancer is radical prostatectomy (RP) and involves removing the prostate gland and some of the surrounding tissue. If the tumour has spread to the lymph nodes, they may also need to be removed.

 
Surgery is a treatment option when the tumour is localised and has not spread outside the prostate.
 

radioterapia prostata

Radiotherapy uses ionising radiation to destroy the tumour. It is a non-invasive and painless treatment that achieves disease control with good results, minimising side effects
 
Radiotherapy with curative intent may be given:
 

  • As first line treatment, in localized tumours of either low, intermediate, or high risk.
  • In addition to other treatments such as hormone therapy, immunotherapy, or targeted therapy in those patients at higher risk.
  • After surgery, in order to eliminate residual disease.

 
In cases where the disease is advanced, radiotherapy may improve symptoms caused by the disease.

Depending on the type of radiotherapy you are going to receive, your radiation oncologist may recommend the use of a SpaceOAR (organs at risk spacer).
 

What are hydrogel spacers?

 

SpaceOAR is a gelatinous substance that is temporarily placed between the rectum and prostate in order to reduce the dose to the rectum, thus minimising possible radiotherapy-associated side effects such as proctitis, rectal bleeding or faecal incontinence.

 
This spacer is made of a biodegradable material that is absorbed over a period of approximately 6 months (due the process of hydrolysis) remaining intact during the first 3 months, sufficient time for treatment administration.
 

When are they indicated?

Today, with advances in treatment using IMRT (intensity-modulated radiotherapy) and IGRT (image-guided radiotherapy), the rate of rectal complications has decreased significantly.
 
However, in treatment with extreme hypofractionation (SBRT) in which the dose per fraction is very high, higher precision is needed, spacers have therefore become an indispensable tool for this treatment to prevent the high doses per session from reaching healthy organs.
 

What does the procedure involve?

Its safe application is carried out during a minimally invasive procedure, performed by trained specialists, either urologists or radiation oncologists. Generally, if the patient requires fiducial marker placement, fiducial markers and spacers are inserted during the same surgical procedure and the patient goes home on that same day, with very few side effects.

*Fiducial markers are small gold seeds that are placed, as a reference, on or around the tumour to indicate its exact position. Higher doses of radiation can therefore be delivered more accurately, without damaging nearby healthy tissue.

 
HC Cancer Center uses VUE Hydrogel. In addition to the advantages of conventional hydrogel this can also be visualized on CT. This enables it to be seen throughout IGRT treatment to ensure correct positioning, it also improves the quality and accuracy of contouring on the simulation CT, guaranteeing more precise and safe radiotherapy.

hormonoterapia_prostata

Hormone therapy aims to reduce levels of male hormones in the body to prevent these hormones from stimulating the growth of tumour cells.
 
Hormone therapy may be given:
 

  • When the cancer has spread to other parts of the body.
  • If there is a recurrence and the cancer reappears.
  • Together with radiotherapy treatment, when it is a high-risk tumour.
  • Before local treatment (radiotherapy or surgery) in order to reduce the size.

 
Types of hormone therapy:

  • LHRH analogues. These are drugs that prevent the production of testosterone. They prevent cells in the body from receiving the command to build testosterone.
  • Antiandrogens. These are drugs that prevent testosterone from reaching tumour cells.
  • Orchidectomy. Surgery removes the lower part of the testicles to prevent them from releasing hormones.

quimioterapia urologia

Chemotherapy is used when cancer has spread to other parts of the body and hormone therapy is no longer effective.

inmunoterapia_urologia

Tumour cells produce proteins that prevent the immune system from identifying these cells as abnormal cells and therefore prevent it from attacking them.
 
Immunotherapy blocks the action of these proteins and strengthens the immune system to identify and destroy these cells.
 
Immunotherapy is a treatment option that is currently under investigation (clinical trials) for advanced-stage prostate cancer which is no longer responding to hormone therapy.

terapia dirigida urologia

Targeted therapy is the basis of precision medicine, this focuses on the study of genetic mutations present in the tumour to be able to deliver precise treatment targeted at the tumour rather than at healthy tissue.
 
In prostate cancer we use gene sequencing tests (NGS) to study for hereditary predisposition, and also to find out if there are defects in DNA repair to assess the possibility of targeted treatment with oral drugs called PARP inhibitors.

Consultants

Dr. Arrazola, Tomás
Especialista en Farmacia Hospitalaria
Especializado en terapia contra el cáncer, certificado por la Sociedad Americana de Farmacéuticos de Hospital

Tel.: +34 952 908 628

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