Prostate Cancer

Prostate Cancer

Prostate cancer is the most common cancer in men. One in six men will be diagnosed in his lifetime. Statistically, one in thirty-five men will die from prostate cancer.

While in Europe two hundred prostate cancers are diagnosed per hundred thousand inhabitants, in the Canary Islands this number is sixty-six, which means that in the islands one third of these cancers are detected compared to the rest of Europe.

This low rate of diagnosis in the Canary Islands forces us to reflect on the fact that the centres of reference should carry out assistance processes for a better diagnosis and thus be able to detect a greater number of cases at earlier stages.

If we can diagnose cancer at an early stage, we can almost always offer the patient curative treatment and a good quality of life.

In our center, we have the best technology for the early detection of prostate cancer such as the microultrasound technique and fusion biopsy.

What is prostate cancer?

Prostate cancer is one of the most common cancers in men and occurs in a small gland that produces the seminal fluid that nourishes and transports sperm.

What is early diagnosis of prostate cancer?

Prostate cancer in its early stages has no symptoms. As prostate cancer can only be cured in the early stages, it is important to have check-ups with a urologist from the age of 40-45.

What are the basics of prostate cancer screening?

Although there are a large number of tools available today to diagnose this cancer, none of them offer 100% certainty. Therefore, the challenge for the urologist is to know which tool to use in each case in order to offer the best and quickest diagnosis.

What are the main diagnostic tests for prostate cancer screening?

The best known system is PSA screening. But routine PSA level monitoring may not be enough, as some prostate cancers do not raise PSA and these are usually the most aggressive.

In our center we perform a rectal examination, because it is still a fundamental tool in the diagnosis of prostate cancer. It is a painless test, which arouses some rejection in those who do not know it for fear of pain and other myths and hoaxes.

Likewise, within the diagnostic means is the Nuclear Magnetic Resonance, it is an image test without radiation. It is one of the most powerful tools we have in our center for the diagnosis of prostate cancer. It provides anatomical and metabolic information of the prostate that will reassure us or, on the contrary, will indicate a biopsy.

We request it when we have a diagnostic suspicion based on test data or digital rectal examination. The MRI is assessed by an experienced radiologist and urologists. After careful examination, a Pirradsclassification is obtained.

Each prostate is categorised with a score ranging from 1 to 5. When the Pirrads score is 3, 4 or 5, a prostate biopsy should be indicated.

Combined biochemical-cellular studies : these are performed with the patient's urine after prostate expression, and sometimes help us to decide on a biopsy. They are sometimes indicated when, after performing the biopsy or MRI, we still have doubts.

Genetic studies: Obtained through saliva, blood or urine samples: we use them in patients with a family history of cancer.

Prostate biopsy is the only test that gives an accurate diagnosis. The classic transrectal technique has fallen into disuse because of its poor results and because it is dangerous. The probability of success in classic transrectal biopsies is 30%. This means that patients sometimes have to repeat several biopsies and that the PSA continues to increase, which generates a lot of anxiety and confusion in the patient.

In addition, by passing needles through the rectum, which is an area contaminated by multiple bacteria, there is a risk of infections that can sometimes be serious, such as urological sepsis.

Therefore, our biopsy technique is performed through the perineum (the area between the testicles and the anus) using the transperineal fusion technique.

On the other hand, we have the microultrasound technique . The fact of having such a high resolution microscopic image, 300% higher than other ultrasound scanners, allows us to differentiate in detail the different areas of the prostate. Some of them, as they grow differently from the rest and follow suspicious patterns, can be biopsied on the spot, giving us the possibility of offering accurate and immediate diagnoses to our patients.

Micro-ultrasound detects up to 16% of additional images that were not possible to detect with the best imaging until then, magnetic resonance imaging.

What kind of treatments are available for prostate cancer?

If prostate cancer has been diagnosed early, we can offer different types of curative treatments. Appropriate treatment of the disease improves the survival and quality of life of patients.

It may seem difficult to choose a treatment given the wide range of variables that this disease presents. At GUA we design an optimal treatment for each case, more or less invasive depending on the characteristics of each patient and the aggressiveness of the cancer.

Prostate cancer can range from being a mildly aggressive disease to being lethal in a short period of time. This is why the professional must offer and agree with the patient the exact type of treatment at each stage of the disease.

The curative treatments for this pathology are:

  • Surgery: 3D high definition laparoscopic radical prostatectomy: Radical prostatectomy surgery is for us the optimal treatment in most cases. High definition 3D laparoscopic surgery offers better vision, so the precision of our leading surgeons is greatly increased, resulting in greater accuracy, less blood loss and a better functional and aesthetic outcome. At GUA we are very precise to ensure the best results and to avoid the patient suffering from incontinence and/or sexual impotence later on. It is a surgery that we normally perform in two hours. On the same day the patient is in the hospital room eating and walking. One month after the operation, patients can lead a normal life, return to work, do sport, etc.
  • Radiotherapy: Radiation therapy is performed by applying external beam radiation through a large machine that aims a beam of radiation at the tumour. The area to be treated is identified by a small tattoo below the navel which allows the radiation therapist to target the organ. External radiation treatments are usually given 5 days a week for a period of two to three months, during which time the patient must come to hospital for treatment. Often along with radiation therapy, hormones must be administered to chemically castrate patients to lower the PSA. Whenever possible, surgery is used as the first treatment option for the following reasons:
    • Radiotherapy is a long treatment, which can take up to 3 months to complete, with the patient having to go to hospital every day. Unlike surgery, which requires two hours of treatment and two days of hospitalisation.
    • In surgery we can remove the entire prostate and lymph nodes from the body for analysis. This gives much more information to better treat prostate cancer. With radiotherapy, the prostate and lymph nodes always remain inside.
    • The long-term side effects of radiotherapy accumulate, which is why we never perform it on young people. These side effects can include frequent bleeding from the bladder, radicular cystitis and even an increased incidence of bladder tumours after 10 years of treatment.
  • Other options that may be offered for the treatment of prostate cancer include:
    • Active tumour surveillance (do nothing) in selected cases.
    • HIFU: transrectal application of high temperatures.
    • Cryotherapy: Application of transrectal freezing.

How is prostate cancer monitored?

Once the patient has been treated, he or she must continue to be monitored at our clinic with periodic PSA tests: this is the tool that allows us to know if the cancer has gone into remission.

Other functional aspects such as quality of urination without leakage and good sexual function are also monitored.

At our centre, we include follow-up consultations and check-ups for six months after the operation.

  • Surgery: high-definition 3D laparoscopic radical prostatectomy.
  • Radiotherapy
  • Active tumour surveillance (do nothing) in selected cases.
  • HIFU: transrectal application of high temperatures.
  • Cryotherapy: Application of transrectal freezing.

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