What's new in prostate cancer

Written by: Dr. Gilberto Chechile Toniolo
Published: | Updated: 18/02/2018
Edited by: Top Doctors®

 

Multiparametric Nuclear Magnetic Resonance (NMR)

Although nuclear magnetic resonance has been used in prostate cancer since the 1980s, its usefulness has increased in recent years by combining conventional T1 and T2 imaging with various functional imaging modalities such as diffusion (DWI ), dynamic contrast study (DCEI) and spectroscopy (MRSI). This is known as multiparametric NMR. This resonance is the imaging technique with greater sensitivity and specificity in prostate cancer, as it offers the specialist in Urology information for the diagnosis, location and extent of the tumor. It is also useful to detect tumors of the anterior area of ​​the prostate that are not detected with the conventional biopsy. All these parameters are collected in a score from 1 to 5 (PI-RADS system) where lesions 1 are benign, 2 are possibly benign, 3 are doubtful, 4 are possibly malignant and 5 are very possibly malignant. Therefore, patients with PI-RADS lesions 4 and 5 should undergo biopsy and those with lesions 3 should be closely monitored.

 

Guided transperineal biopsy with template (Brachytherapy Technique)

At present, biopsy remains the only method to diagnose prostate cancer. However, it is a technique that is not free of complications since in many patients with repeatedly elevated PSA values ​​must be repeated several times. The increase in the number of cylinders obtained with transperineal biopsy with template, which is the same technique used to implant the brachytherapy sources, allows to detect tumors located in the anterior area of ​​the prostate that can not be reached with the usual technique transrectal prostate biopsy. This technique allows mapping of the entire prostate gland without risk of infection and diagnosing between 30% and 40% of cancer patients who would not be diagnosed with conventional prostate biopsy. The limitation of this technique is that it must be performed with spinal or general anesthesia. In cases with a previously negative conventional biopsy, detection with biopsy with brachytherapy technique is of 55%, with two negative biopsies is of 42% and with three previous biopsies negative 34%. With this technique, all the lesions observed in the multi-parameter NMR can be reached.

Prostate biopsy by fusion of images

The newest technique for detecting prostate cancer combines the images obtained with multi-parameter MRI and the images obtained with real-time transrectal ultrasound (image fusion) using a computer program to direct the needle to the suspicious lesions of malignancy (PIRADS 4 and 5). With this technique, the need for biopsies in men with PSA elevation decreased by 51%, the diagnosis of low risk cancers decreased by 89% and the detection of intermediate and high risk cancers increased by 18% compared to biopsies obtained with only transrectal ultrasound.

 

What can patients do to help control the disease?

The answer is to change lifestyle habits and diet. In 2005 a study was published in the Journal of Urology at the University of California, San Francisco, with patients with prostate cancer who had refused active treatment against the tumor. Patients who changed lifestyle (vegetarian diet, antioxidant vitamins, omega 3 fatty acids, physical exercise and anti-stress courses) showed a decrease in PSA compared to those who did not make these changes.

In addition, at 12 months, 12% of patients who had not changed their lifestyle had to be operated on by progression of their cancer, whereas none of the patients who had changed their lifestyle had to resort to surgery. Since then several comparative studies have been published which show that changes in the diet of patients with prostate cancer are useful in reducing the progression of the disease after failure of curative treatment with surgery or radiotherapy. Phytotherapeutic agents (polyphenols) with potential benefits in patients with prostate cancer are: green tea, turmeric, pomegranate, pomegranate, sulforophos and indole-3-carbinol from cruciferous vegetables (broccoli, cauliflower, cabbage), garlic, mushrooms , maitake), resveratrol (red wine), ginger, lycopene (tomato), dark chocolate. The mechanisms by which anticancer effects are produced develop at various cellular levels (inhibition of proliferation, cell cycle arrest, induction of apoptosis, etc.). In a randomized UK study, patients with locally active prostate cancer treated with a capsule containing pomegranate, green tea, broccoli and turmeric showed at six months that PSA had risen by an average of 9 % while in those receiving placebo the PSA rose 80%. In another randomized trial conducted at the Johns Hopkins Cancer Center (USA), patients with prostate cancer and PSA elevation due to failure of initial treatment (biochemical relapse) received 1 or 3 grams of pomegranate per day for 18 months. The time of duplication of the PSA (burned the evolution of cancer) was extended from 12 months at the beginning of the treatment with pomegranate to 18.5 months at 18 months. In 13% of the cases the PSA decreased. In 80% of cases treated with pomegranate the PSA stabilized. On our websites, under the "Cancer Advice" tab you will find extensive information on the beneficial effects of diet in patients with different cancers.

*Translated with Google translator. We apologize for any imperfection

By Dr. Gilberto Chechile Toniolo
Urology

Dr. Chechile has over 30 years of experience practicing in centers of excellence. It is one of the leading specialists in the treatment of prostate cancer using brachytherapy and currently heads the Technology Medical Institute.

*Translated with Google translator. We apologize for any imperfection

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