Cancer of the prostate
"No institution in Spain, and few worldwide, has all the combination of state-of-the-art diagnostic means that allow us to offer the most personalized treatment possible for prostate cancer".
DR. BERNARDINO MIÑANA LÓPEZ
DIRECTOR. UROLOGY DEPARTMENT
Prostate cancer is the most common malignant tumor in men in the European Union, although it is exceedingly rare before the age of 50. Ninety percent of cases occur in men over 65.
Advances in imaging techniques and early detection programs for prostate cancer now make it possible to diagnose the disease in its early stages in 70% of patients.
Therapeutic advances in the fields of surgery and radiotherapy mean that currently localized prostate cancer treatments are associated with a 10-year survival rate of almost 100%.
The multidisciplinary approach of the Prostate Cancer Area of the Cancer Center Clínica Universidad de Navarra, with the joint or sequential action of the specialties involved (Urology, Radiology, Pathological Anatomy, Radiotherapeutic Oncology and Medical Oncology), is the ideal scenario to guide and treat the patient.
This area carries out an early diagnosis program for patients over 50 years of age. These programs are of vital importance since, on many occasions, prostate cancer does not produce symptoms and is detected in routine check-ups.
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What are the symptoms of prostate cancer?
Prostate cancer does not have a characteristic clinical presentation. Diagnosis is often made based on a routine medical checkup of an asymptomatic patient.
On occasion, the disease first manifests through increasing difficulty in urination or due to blood in the urine.
It may also present without any symptoms related to urination, instead showing with symptoms due to the spread of the disease outside the prostate, in particular bone pain.
Do you have any of these symptoms?
You may have prostate cancer
What are the causes and risk factors?
- Age is one of the main risk factors for prostate cancer. In fact, more than 70% of cases occur in men over 50.
- Another aspect that must be taken into account is the existence of genetic factors. Family history doubles the risk of suffering the disease, especially when two or more direct first-degree relatives (father or brothers) are affected by prostate cancer.
- There is no proven link between prostate cancer and having had a sexually transmitted disease or vasectomy.
- Health habits also influence the possible appearance of prostate cancer and are closely related to poor nutrition, obesity and sedentary lifestyles.
- Smoking is another factor that may favor the appearance of this cancer, since it increases hormone secretion, which makes the tumor grow.
- Race is another risk agent. It occurs about 70% more often in African-American men.
Precision in the diagnosis of the location and malignant potential of prostate cancer
For three years now, we have been the only comprehensive centre that systematically uses the combination of multiparametric magnetic resonance imaging (MRI) with transperineal image-fusion biopsy in all its patients (more than 1,000 biopsies performed).
This is because our objective is threefold:
- Firstly, to determine whether the patient has prostate cancer with maximum safety by avoiding second biopsies.
- To find out the location of the tumour inside the prostate.
- To obtain samples directly from the tumour, which allows us to know its biology in the most precise way, something that is essential for the application of a treatment in proportion to the severity and extension of the disease.
In patients with high-risk tumours where the disease may have come from the prostate, we carry out the extension study with a Choline PET. This extremely sensitive test enables us to adapt the treatment to the characteristics of the patient.
By combining it with the fusion biopsy, we have managed to treat patients with high-risk tumours with complete preservation of continence and sexual function.
Having incorporated this innovative technique in December 2018, we have carried out more than 400 procedures in one year.
This technique is indicated in patients whose primary treatment through surgery, radiotherapy or a combination of both has failed and is detected by an elevated PSA.
It informs us exactly of the location of the tumour, even before it is visible with other techniques. As a result, we have become the first group that has been able to standardise recurrence patterns and what the most appropriate treatment for each one would be.
We are pioneers in these treatments that are always conducted using minimally invasive techniques.
In addition to imaging tests, we carry out a molecular diagnosis determining biomarkers to evaluate which patients can benefit from conservative treatments and to assess the possibility of performing personalized treatments in patients with advanced tumors.
How is prostate cancer treated?
For prostate cancer limited to the gland, not extended according to previous clinical trials, we can provide the following treatments in addition to the active surveillance we apply in selected cases.
It involves treating the affected part of the prostate with a safety margin to control the tumour while preserving continence and sexual function. To achieve this, we use irreversible electroporation, high intensity focused ultrasound (HIFU) or high rate brachytherapy depending on the location of the tumour.
We are pioneers in this approach, having the most followed series in the country. We have managed to control the tumour in 96% of the cases in the treated area, maintaining continence in 100% and erections in 96%.
Da Vinci® Robot Assisted Radical Prostatectomy
Although we also perform this procedure by pure laparoscopy in selected cases, robotic surgery offers the maximum guarantee for our patients due to its high precision and fast recovery.
We have a continence rate close to 100% in the update and a conservation of the sexual potency that depends on the aggressiveness of the tumor, its location and the age and previous diseases of the patient.
When the conditions of the tumour and the patient are favourable, the conservation of sexual potency is greater than 90%, with or without associated drugs.
High and low rate brachytherapy in monotherapy
We use brachytherapy either to treat the entire prostate or the affected part with a safety margin (focal therapy).
With the low rate technique we introduce radioactive iodine or palladium seeds by transperineal route in the selected areas that make their effect over several months.
With the high rate technique we administer the complete dose, from a radioactive Iridium source, in two sessions separated by 12 hours so that the patient receives the total dose before being discharged 24 hours after admission.
External radiotherapy with V-MAT
It is a form of intensity-modulated radiotherapy in which the radiation is administered with a unit that makes a 360º turn, which allows adaptation to the volume and shape of the prostate, managing to reach the desired doses with a minimum radiation of the surrounding tissues. Compared to the more conventional forms of external radiotherapy, this translates into more precise, faster treatment with fewer adverse effects.
External radiotherapy with proton therapy
In 2020 we have incorporated into our therapeutic arsenal the greatest advance in radiotherapy involving proton therapy, which gives us the maximum guarantee of reaching the appropriate doses while respecting the surrounding tissues and, therefore, possible adverse effects.
When a previous treatment with surgery, radiotherapy or both, expressed by the presence of a rising PSA, has failed, the information provided by the PET Ga PSMA allows us to know its location in advance.
Once again, the MRI and biopsy with fusion allows us to confirm the presence and biology of the tumour, a necessary previous step to programme any rescue treatment, always from the perspective of minimum invasion.
We have pioneered the rescue of patients with local or nodal recurrence through robotic surgery, transurethral resection and SBRT radiotherapy.
Some may benefit from treatment with irreversible electroporation or high rate brachytherapy, depending on their location and previous treatment.
As there is no previous experience worldwide, all these treatments are considered experimental and are part of a prospective study, approved by the Ethics Committee.
Owing to PET Ga PSMA, we are capable of detecting metastatic prostate cancer more quickly than conventional methods, which allows us to provide earlier systemic treatment, either with therapies aimed at androgen receptor-dependent growth, or with systemic chemotherapy, or through inclusion in some of the cutting-edge clinical trials in which we participate.
It has been demonstrated that the earlier the treatment with these agents is carried out, the greater the expected benefit will be.
What clinical trials do we have on Prostate Cancer?
Where do we treat it?
IN NAVARRE AND MADRID
The Prostate Cancer Area
of the Cancer Center Clínica Universidad de Navarra
We provide the patient with a medical team, made up of first class professionals, and state-of-the-art diagnostic and therapeutic means such as Da Vinci® robotic surgery.
The Urology Department, which is part of the Prostate Cancer Area, has the accreditation certificate of the European Board of Urology, a reinforcement of the excellence of the service at the level of care, teaching and research, which only three hospitals in Spain have.
No other institution in this country, and few in the world, has all the combination of state-of-the-art diagnostic means that allow us to find out what is specific to the disease in each patient in order to offer the most personalized treatment possible.
Diseases we treat:
Why at the Clinica?
- A team of top-level professionals trained in international centers.
- State-of-the-art technology for diagnosis and treatment.
- In 24-48 hours you can start the most appropriate treatment.
Our team of professionals
Why choose our Clinic?
"The first step in combating prostate cancer is an early diagnosis that is as accurate as possible."
All the keys to this disease from our best experts, Dr. Bernardino Miñana, co-director of the Department of Urology, Dr. Macarena Rodríguez Fraile, specialist of the Nuclear Medicine Service, Dr. Javier Aristu Mendióroz, clinical director of the Proton Therapy Unit. Dr. Macarena Rodríguez Fraile, specialist of the Nuclear Medicine Service, Dr. Javier Aristu Mendióroz, clinical director of the Proton Therapy Unit.