THE OPTIONS
Radical prostatectomy , Laparoscopy, Robotics, DaVinci, Brachytherapy, External beam radiation, Gamaknife, IMRT, Protons, HIFU, Criotherapy, Photodynamic therapy, RF, Microwaves, IRE/ Nanoknife, Active surveillance, Hormone therapy, Chemotherapy.
When confronted with this diagnosis the patient can be overwhelmed with the numerous available alternatives. So what is the ideal therapy?
Simplifing in a systematic fashion, Instituto de Terapia Focal da Próstata divides the options this way:
• Advanced systemic disease:
Hormone therapy and Chemotherapy
• Locally advanced disease:
Radical Prostatectomy, Laparoscopy, Radiotherapy, IMRT,(+-Hormone therapy)
• Localised disease:
Radical Prostatectomy, Laparoscopy, Robotics (DaVinci), Radiotherapy, Gamaknife, IMRT, Protons, HIFU, Criotherapy, Photodynamic therapy, RF,
Microwaves, IRE/Nanoknife.
• Localised low risk disease:
Active surveillance
The range of therapeutic options is nevertheless vast!
Systematically:
• Radical Therapies:
Radical Prostatectomy, Laparoscopy, Robotics (DaVinci), Radiotherapy,
Gamaknife, IMRT, Protons (Whole gland treatments with a safety margin outside the gland)
• Focal Therapies:
HIFU, Criotherapy, Photodynamic therapy, RF, Microwaves, IRE/ Nanoknife
(only tumor foci. are treated, with a safety margin)
Within focal therapies:
• Thermal:
HIFU, Crio, Microwaves, RF (Destruction by temperature change - Inflamation)
• Athermal:
Photodynamic therapy, IRE/Nanoknife (No change in temperature to destroy the lesions - lesser/absent inflammation)
• Active surveillance:
Low risk cancer can be managed through a surveillance protocol.The rationale is that this kind of disease has a very slow course and a systematic surveillance of the PSA, MRI, and repeated biopsy, allows for the maintenance of an adequate therapeutic window.
At any time, if there is evidence of change in the aggressiveness of the cancer the patient is switched to any of the other treatment modalities, maintaining adequate outcomes.