Our goal is to obtain the cure with the minimum of adverse effects and adapted to the values and preferences of the patient
Prostate cancer is the most common malignant disease in men with about 30,000 new cases diagnosed each year in our country. Missing the causes, it is of high importance to carry out a diagnosis as early as possible in order to be able to treat it with maximum guarantees and minimum adverse effects.
In our country, two out of every three men are diagnosed due to a rise in PSA, often asymptomatic. When a male consults for symptoms related to the lower urinary tract, they are usually attributable to benign prostatic hyperplasia, a disease that can coexist with prostate cancer.
About 90% of new diagnoses are located in the prostate, which offers the possibility of trying to administer curative treatments adapted to the peculiarities of the disease in each patient.
No institution in this country and few worldwide, have the whole combination of state-of-the-art diagnostic means that would allow us to respond to the specific characteristics of the disease of each patient in order to offer him the most personalised treatment possible.
A PERSONALIZED MEDICINE
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At the Prostate Centre we have all the diagnostic and therapeutic techniques necessary to offer the best option according to the characteristics and preferences of the patient.
A team of highly experienced professionals
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.
Maximum oncological control with minimum adverse effects for the patient
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.