Prostate cancer treatment

Diagnosis and treatment program for prostate cancer in 2020 (International protocols according to NCCN and ACS)

How patient is being examined in the world’s advanced clinics?

Recently developed screening tests now allow identifying prostate cancer more accurately than PSA (PHI, 4Kscore, PCA3, TMPRSS2: ERG, EPI, ConfirmMDx). A patient with low scores can do without transrectal ultrasound (TRUS), biopsy, and related complications.

MR / ultrasound fusion biopsy is the most accurate sampling method for research. It shows «blind» zones for TRUS and gives the correct diagnosis after the first procedure. Samples from the «clean» areas are not taken, which reduces the invasiveness of the procedure.

The new types of PET-CT scans can detect cancer foci with an accuracy of 1 mm even in the blind areas for MRI, CT, and osteoscintigraphy. Ga68-PSMA, C11 / F18-Cholin, or F18-Fluciclovine are used for different tasks in the search for cancer cells.

Genetic tests of tumor mutations and DNA predict how the disease will develop without treatment. (Oncotype DX Prostate, Prolaris, ProMark, Decipher). According to the results, patients at low risk can refuse surgery and radiation therapy, without the risks of complications.

What treatments for prostate cancer are used in advanced cancer centers?

Surgery — tumor removal. To reduce risks and side effects, the surgery is performed on a Da Vinci robot, or TURP transurethral resection of the prostate is used.

Alternative non-surgical methods are ultrasonic scalpel (HIFU), laser (TOOKAD), microwave scalpel (NanoKnife) for the early stages and radiofrequency and cryoablation for the late stage. It removes the tumor without incisions.

Hormone therapy is a group of techniques: from surgical castration to the latest drugs: abiraterone (Zytiga), enzalutamide (Xtandi), apalutamide (Erleada). This type of treatment blocks the growth and division of prostate cancer cells.

Chemotherapy — drugs that slow down and disrupt the division processes in the cells. Recent studies have proven the effectiveness of the two drugs for the treatment of prostate cancer: docetaxel and cabazitaxel.
Immunotherapy is the latest drug for the treatment of prostate cancer (sipuleucel-T, pembrolizumab, and nivolumab). They change oncological cells so that the immune system starts to perceive them as heterogeneous bacteria. Human immunity destroys such cells.

Targeted therapy — drugs that block the formation of cancer cells in men with specific hereditary mutations (olaparib, rucaparib, and niraparib for BRCA2 mutations). The second group of targeted drugs destroys cancer cells with specific mutations (monoclonal antibodies).

Radiation therapy — these new devices with advanced tracking systems for the movement of the bladder, intestines, and prostate, revolutionized prostate cancer treatment. During the session, the machine dynamically adapts the rays to the tumor with maximum accuracy. This will destroy the lesion, preserving the prostate, erection, and urination function.

The treatment of prostate cancer with chimeric antigen receptors — which recognize and destroy cancer cells throughout the body, is being investigated. It is available only at a few research institutes in the world.

What surgical procedures for prostate cancer are performed in specialized centers?

Traditional methods:

Open surgery with access through the pubis or perineum. Occasionally is used in stages III-IV and removes fiber and lymph nodes in full. Rehabilitation takes 3-4 weeks.

Laparoscopic surgery through the rectum is less traumatic. Recovery takes 1-2 weeks. The frequency of erectile dysfunction and urination disorders does not differ for open and laparoscopic surgery.

Innovative methods:

Transurethral resection of the prostate (TURP) is carried out using a resectoscope, which is a thin metal tube containing a light, camera, and loop of wire. This is passed along the urethra until it reaches the prostate, which means no incisions need to be made. The procedure lasts 1 hour and does not require complex skills from the doctor. Used to reduce symptoms, but not to cure prostate cancer! Therefore, it is necessarily combined with other methods (radiation therapy, targeted therapy).

Robotic operation is a laparoscopic removal with the Da Vinci robot. The method minimizes blood loss, pain, and the duration of rehabilitation after surgery. The frequency of urination disorders and erectile dysfunction may be lower than with standard laparoscopy, however, this is more dependent on the experience and skills of the surgeon, and not on the method itself.

How to choose a clinic for prostate cancer treatment?

Specialized cancer centers in countries with advanced medicine show the best success rates for prostate cancer treatment — about 98%. New diagnostic methods allow you to quickly and accurately identify prostate cancer, predict its development, and choose the right treatment tactics. The surgeon’s experience determines the risk of recurrence of the disease, the invasiveness of the surgery, and the timing of rehabilitation.

Erectile dysfunction and impaired urination after surgery develop in less than 25% of patients if the doctor performs it efficiently. In the leading clinics, non-surgical treatment methods are available that allow you to recover without incisions and rehabilitation, staying at the clinic for only a few hours.

Modern drugs of immunotherapy and hormonal therapy have made it possible to do without the surgical castration of men. Such drugs have fewer side effects, and the addiction of the body takes much longer, which allows you to continue taking drugs in low doses.