Thanks to the important advances in science and to increasingly early detection of prostate cancer, the most common tumor among men, the concern of most of these patients has altered from being that of a cancer patient to being more focused on issues of quality of life. "Now, patients ask more if they should be treated and if there is any way to treat prostate cancer without the classic side effects of surgery and radiotherapy - urinary incontinence and sexual impotence," says Dr. Carlos Nuñez, head of the Urology Department at MD Anderson Cancer Center Madrid.
Thus, although the incidence of prostate cancer continues to rise, the good news on a date such as June 11, World Prostate Cancer Day, is that "every time we detect tumors early on and, therefore, every time we diagnose more localized tumors, against which we can use two strategies - active surveillance and, more recently, focal therapy", says Dr. Nuñez, who describes the latter, still quasi-experimental technique as "an authentic revolution for patients".
The arrival of this therapy would not have been possible without the advances that have been made in recent years in imaging techniques. The arrival of tools such as magnetic resonance imaging, HistoScanning or fusion biopsies have made it much easier to locate a tumor, even a small one, in the prostate.
And, thanks to this, the development of focal therapy has been possible, a set of techniques whose objective is to use some type of energy to treat only the area around the tumor, with a margin of safety, but without extending the treatment to the rest of the prostate. Therefore, focal therapy is indicated only in "patients with very localized tumors that affect only a very specific part of the prostate", says Dr. Nuñez, who points out that, fortunately, these tumors are the most commonly seen in the doctor’s office today.
Cryotherapy, one of the most promising techniques of focal therapy
One of the techniques comprising focal therapy is cryotherapy, which involves inserting needles around the tumor capable of freezing the tissue rapidly to reach temperatures of 40 degrees below zero to subsequently heat the tissue rapidly, with the aim of causing the total destruction of the cancer cells.
Although there are no long-term results for this technique, Dr. Nuñez does speak of "very promising results in the medium term". Specifically at MD Anderson Madrid, Dr. Nuñez’s team has data on a series of 30 patients who, after 2-3 years of having undergone cryotherapy, have not suffered relapse. And not only that, but 100% of the subjects remain continent and between 80-90% of the subjects have not lost sexual potency. With these results on the table, and although it is true that currently there are not many centers that perform this technique, Dr. Nuñez believes that focal therapy could become a standard treatment in the future.
In addition to cryotherapy, focal therapy also includes high intensity focused ultrasound (HIFU) ablation, which locates the tumor and emits a series of shock waves that heat the tissue to 90 degrees until destruction, and electroporation, which creates a Galvanic arc around needles to destroy the tumor by means of the electricity created around those needles placed around the tumor.
Active surveillance, an option for less aggressive tumors
Although less innovative, active surveillance is a strategy that is also widely used in the diagnosis of prostate cancer. Indicated primarily in elderly patients with "mild tumors and stable PSA levels", Dr. Nuñez explains, active surveillance consists of observing the patient continuously, performing biopsies every 12-18 months, in order to determine if the patient’s tumor is potentially harmful or not in order to carry out a treatment or not.
Currently, in addition to the mere observation of the patient, it is also possible to use certain genetic markers to determine the aggressiveness of the tumor, which allows the medical professional to make a decision about the treatment of each patient with prostate cancer with greater accuracy.