Prostate cancer: to the advantage of surgery

Cancro da próstata: Vantagem para a cirurgia

Considering such a broad choice of therapies, which depend on the risk of the illness, it became clear that any decision is always made by a multidisciplinary team and discussed with the patient. However, recent studies indicate radical surgery as the first choice.

Prostate cancer: to the advantage of surgery

The symposium on “Treatment options in localized prostate cancer” sought to bring new ideas to one of the most highly debated areas of oncological urology, prostate cancer treatment, as José de Vilhena-Ayres put it, one of the directors at the symposium and coordinator of the Urology Department at Hospital da Luz.
The first speaker, professor Álvaro Martinez, senior vice-president of the Scientific and Clinical Strategy for Michigan Healthcare Professionals/21st Century Oncology, addressed the topics of low dose brachytherapy, high dose brachytherapy and personalised external radiotherapy, and started by mentioning that experts normally stand up for their field of expertise. So, as a radiotherapist he supports his science, whereas any surgeon would defend radical prostatectomy.

Nonetheless, he presented several trials and studies, while underscoring that all types of therapy, from active vigilance to surgery, including radiotherapy, hormone treatment and chemotherapy must be weighed against the stage of development of the cancer localised in the prostate and discussed in a multidisciplinary framework, before submitting them and discussing them with the patient.

Rafael Ernesto Sanchez-Salas, surgeon and researcher at the Institut Mutualiste Montsouris, in Paris, a pioneer institution in focal treatment (“HIFU”) and in robotic surgery, addressed “High-Intensity Focused Ultrasound” therapy, which he finds to be a very reasonable form of managing low, and perhaps even moderate, risk prostate carcinoma patients. He underscored, however, that it is an experimental therapy, for which results must still be validated and require more clinical evidence.

Study supports prostatectomy

Peter Wiklund, urologist and robotic surgeon, professor in oncological urology at Karolinska Institutet, Stockholm, introduced the findings of a comparative study on the efficacy of radical prostatectomy and radiotherapy for prostate cancer treatment, based on mortality outcomes in Sweden, a survey that is soon to be published in a scientific paper by the prestigious British Medical Journal. The patient follow-up study lasted 15 years– according to Peter Wiklund 10 years is too short a period for a study on prostate cancer, a disease that progresses very slowly, compared to other cancer types.

In this regard, the urologist added that in Sweden there is a National Prostate Cancer Registry, which covers 98% of all prostate cancer cases, 34,515 people in total, who have been monitored since the disease was diagnosed.

Peter Wiklund presented the data and findings of the study and stated assertively that the risk of death from cancer in the prostate is higher in patients who underwent radiotherapy, compared to those submitted to radical prostatectomy, which he highlighted as first line therapy for curing prostate cancer.

Steven Joniau, professor at the Urology Department at Leuven University Hospital and panel member of the European Association of Urology for the prostate cancer treatment guidelines, subscribed to the treatment options and multidisciplinary decision highlighted in the beginning by Álvaro Martinez, while underscoring too, as Peter Wiklund had done, surgery as a ‘gold standard’ treatment for curing prostate cancer. If surgery is performed at a low risk stage, there is still margin for treating with radiotherapy, he added.

In the following paper, Rafael Ernesto Sanchez-Salas based himself on studies to categorically assert that, “like it or not, robotic surgery is better than other treatment methods of prostate cancer. It may be expensive, but it does the job”.
Steven Joniau, in turn, mentioned active vigilance as an option that should be weighed for some low risk patients, but for which follow up must be strictly established and complied with by patients.