Prostate cancer is a very common tumor since one in six or eight men will suffer from it at some point in their lives. In Spain, it is the third cause of death after colon cancer and lung cancer. If prostate cancer is diagnosed early, the cure rate considerably increases, reaching 95% in cases with low-risk tumors using radical surgery (laparoscopic or robotic) or a less aggressive treatment such as dynamic real-time brachytherapy. It is widely demonstrated that diet and lifestyle play an important role in the appearance and development of prostate cancer. For this reason, it has been considered that, together with diet, maintaining a normal body weight and reducing fat mass may be decisive in reducing mortality from this tumor.
Men with prostate cancer who change their diet and lifestyle (low consumption of animal fats and ultra-processed products, diets rich in soy, physical exercise, reduced stress, etc.) can change the evolution of the tumor and delay its progression. To improve the diagnosis of prostate cancer, we use tumor markers that allow us to identify cases with a higher risk of suffering from it, such as men who have family members who have had it. The markers we use to estimate the individual risk of developing prostate cancer are K4score, SelectMDx and prosTAV. In men, the healing rate is higher or it produces fewer side effects.
This prostate biopsy technique allows us to biopsy all suspicious lesions seen on a prostate MRI. The Koelis robotic system that we have incorporated into our centers allows us to access all regions of the prostate through the skin of the perineal (space between the scrotum and the anus), thereby avoiding infections or sepsis that may occur. with conventional prostate biopsy through the rectum.
If the cancer is only in a small area of the prostate, focal treatment can be performed, thus avoiding treatments of the entire prostate that increase the chances of complications such as erectile dysfunction and urinary incontinence, even if robotic surgery is used.
Focal treatment has several advantages: control of the oncological disease for several years; lower incidence of complications (urinary incontinence, erectile dysfunction); They generally do not affect ejaculation; they respect normal prostate tissue; and possibility of repeating the focal treatment or performing other treatments in the future if necessary.
The focal treatments we have are HIFU (high intensity focused ultrasound) and IRE (irreversible electroporation). Focal treatments are based on image fusion and allow treating the tumor focus with a safety margin of up to one centimeter outside it.
Focal HIFU uses heat produced by ultrasound and is applied from the rectum. It is an ideal treatment for tumors located in the posterior area of the prostate because it is very close to the rectum. In the treated area, the temperature is raised to more than 80ºC, which kills the tumor cells.
IRE (irreversible electroporation) uses high-voltage electrical pulses between needle electrodes placed surrounding the tumor focus. The treatment damages the cell membranes, producing pores (holes) that destabilize them, causing death by apoptosis. It is a treatment for tumors located in the anterior area of the prostate or near the sphincter or bladder since it allows the structures that surround the prostate gland such as the erection nerves, blood vessels or the rectum to be preserved as much as possible.
In tumors that affect several areas of the prostate or whose cells are very aggressive, we have Da Vinci robotic surgery. In less aggressive tumors, low-rate brachytherapy in dynamic real time with Iodine 125, which we have performed since 2003, cures 95% of cases. To date we have treated more than 600 cases with this technique. The advantages of brachytherapy are: low aggressiveness (it does not produce urinary incontinence and the possibility of sexual impotence is very low); tumor cure similar to radical surgery (93% at 12 years in low-risk tumors); and incorporation into your usual work in 24-48 hours.
We have recently incorporated the application of a hyaluronic acid gel into the brachytherapy treatment, which significantly reduces the appearance of rectal complications as it separates the prostate from the rectum.