Apply for a consultation
Apply for a consultation
Apply for a consultation

A smart trap for prostate cancer

Prostate cancer is curable

Prostate cancer is the second most common type of cancer in males in Latvia. Therefore everyone, especially healthy men, should know and be aware of several important factors related to this tumour.

Firstly, the younger is the man suffering from prostate cancer, the more aggressive is the course of the disease. Secondly, if this tumour affected the patient’s father, grandfather or brother, the disease risk increases twofold, and if affected two blood relatives – even five-fold. Thirdly, prostate cancer is dangerous and specific due to the fact that it has no symptoms in early stage and it progresses very slowly – for years, even for decades.

The prostate cancer IS curable at the early stage, therefore men should be alert and check the PSA blood levels at least once a year, even if nothing wrong with you. You should be careful is your PSA level exceeds 4 ng/ml; another dangerous symptom is prompt increase in PSA level.

Unfortunately, due to various environmental factors and lifestyle prostate cancer is found in increasingly younger men. Therefore after the age of 40-45 years should consult their general practitioner once a year and do a blood test to check prostate-specific antigen (PSA) level according to the age-related normal value. As the increased PSA blood level is caused not only by prostate cancer, but by other diseases, in case of changes in this marker you should immediately consult an urologist to find out the cause.

What treatment option should be selected in case of prostate cancer?

Different options can be applied to treat prostate cancer. Every man affected by this disease has a right to know about all treatment options, their progress and side effects, especially since the development of medical technologies has supplemented the range of treatments options by new advanced options allowing making accurate tumour diagnosis and precise treatment with significantly fewer side effects and postoperative consequences.

Surgery without a knife

A modern non-invasive method – robot-assisted stereotactic radiosurgery is available in Stereotactic Radiosurgery Centre of Sigulda Hospital since the end of 2015 which allows eliminating prostate cancer in the early stage. The last generation robot CyberKnife M6 is available in the most modern radiosurgery centre in the Eastern Europe in Sigulda, just like in the best German clinics. Although the name consists of the words “surgery” and “knife”, when CyberKnife technology is applied, there are no incisions, anaesthesia is not required and there is no blood loss.

During therapy, a large dose of ionising radiation is delivered to the tumour with millimetre precision, as a result, the tumour cells are destroyed and their growth is terminated. This therapy is very effective against tumours and at the same time sparing, as the surrounding healthy tissues and organs in the pelvis are protected. Radiosurgery procedure for the prostate usually results in less complications; quality of life is higher than after surgery. As compare with traditional radiation therapy which normally lasts up to 8 weeks, in this case the patient needs to attend procedures five times only (a procedure lasts 45 min.). It is important to ensure a treatment course that will not significantly disturb patient’s routine rhythm of life – during the therapy the patient does not feel anything – heat, cold, or pain, therefore there is no need to stay at hospital, and he can return home right after the procedure.

Patients suffering from prostate cancer are divided into low, medium and high risk groups. Radiosurgery in case of prostate cancer as a separate method can only be applied in patients of low and medium risk groups – in other words, in early stages of cancer. In advanced stages radiosurgery can successfully be applied to eliminate metastases of prostate cancer, for example, in the pelvis, liver, spine and brain. However, the earlier the cancer stage is, the more extensive are treatment options and the more effective is the treatment. Certainly, there are exceptions to every rule. If the tumour is already large, radiosurgery can only partly help, but it will improve the patient’s condition and quality of life.

Benefits after radiosurgery for prostate cancer

The main benefit is undoubtedly the life; however, quality of life after the surgery is also very important. Due to the opportunity to eliminate the tumour precisely, without affecting the prostatic nerves and blood vessels that are “in charge” of the potency, radiosurgery procedure mostly enables to preserve high-quality sexual vigour or potency. Impotency is observed in 25-100% of cases after conventional surgery, but after radiosurgery sexually active men fully preserve their potency in 80-85% of cases. However, if any disturbances occur, they can be successfully compensated by taking potency stimulant medications, if necessary.

The course of surgery, related side effects and recovery period are also important. There are significant differences between conventional surgical treatment and classic radiation therapy. Radiosurgery does not cause severe and fatal side effects, however, surgical treatment performed in even highly specialised centres results in bleeding, episodes of pulmonary thromboembolism and rectal perforation in the postoperative period. Up to 50% of patients suffer from urinary incontinence after the surgery during the rehabilitation period. Permanent incontinence issues are observed in 5-7% of patients. Urinary incontinence as a side effect is less pronounced after conventional radiation therapy, but patients still experience burning during urination, frequent urination and bowel disorders due to urinary bladder and rectum exposure to radiation. Side effects in case of radiosurgery may be similar to side effects after conventional radiation therapy, but they are generally milder and go away much faster. Moreover, recovery period is totally different – after radiosurgery procedures patients do not experience pain and can immediately go home.

More progressive and accurate prostate cancer diagnostic technique

Approximately 15-20% of patients after initial treatment have recurrent cancer which is often indicated by an increase of PSA marker blood level. A thorough patient’s examination is required to find out whether the tumour has returned or metastases have occurred, and to check their localisation. Different visual diagnostic techniques such as magnetic resonance imaging, computed tomography, scintigraphy are traditionally applied, but recent studies have shown that in these cases positron emission tomography/computed tomography (PET/CT) combined examination is the most advanced and accurate examination. Radiopharmaceutical drug 18F-choline which specifically marks the prostate cancer cells is applied, as it allows assessing the spread of prostate cancer and differentiating inflammatory processes from tumours. PET/CT examination is especially important for prostate cancer patients who suffer from the recurrent disease after conventional surgical or radiation therapy. As compared to other examinations, a single PET/CT examination can determine metastases both in soft tissue and in bone system more accurately.

68Ga-PSMA has significant advantages in terms of diagnostic precision, especially in cases of postoperative recurrent prostate cancer. PET/CT examination enables to determine metastases in soft tissues and skeletal system more accurately than other diagnostic methods.

Ga68-PSMA marker can be used to determine very precisely the border between the affected and healthy tissues and presence of malignant cells, even if the PSA level is less than 1.0.

Sensitivity of PSMA PET/CT method is so high that it can help diagnose the smallest bone metastases. This method is beneficial not only for patient with relapses, but also for people with suspected cancer in whose tissue samples tumour could not be identified before.

PSMA PET/CT method allows not only accurate diagnostics, but also planning further therapy. It allows determining whether the patient needs single topical treatment (for example, radiation therapy) or chemotherapy or hormonal therapy course.

PET/CT examination provides high-quality hybrid image in which prostate cancer cells are specifically marked, and accurate information about anatomical tumour data (localisation, size) at millimetre level and functional type of the tumour cells – whether it is active or inactive, malignant or benign. Studies have shown that PET/CT method allows finding metastases in lymph nodes which are smaller than 5 mm. This finding can significantly change the course of treatment. Early metastasis PET/CT diagnostics provides well-timed treatment, reduces the risk of bone fractures and spinal cord compression.

Due to high sensitivity of PET/CT technology, it is especially recommended for an accurate and early diagnostics of all metastases and relapses, which is invaluable information for both physician, who will be able to make precise plan for further treatment, and the patient, since it will improve recovery prognosis.

cyberknife-sigulda

  • Share this post

2021 - © Consilium Veritas