Fusion biopsy, focal therapy and robotic surgery with the Da Vinci system, advances in prostate cancer

Prostate cancer is the most common tumor suffered by men in Spain. According to data from the Spanish Association Against Cancer, so far in 2021, in Spain, more than 35,000 cases have been diagnosed, with a total of 5,986 deaths.

It is a pathology that has different causes, some genetic, due to race or family inheritance. Others, due to external factors such as diabetes, hypertension, obesity or smoking are more debatable there are no preventive measures to reduce the risk of developing prostate cancer.

The probability of suffering from this cancer increases with age and it is considered that 60% of 79-year-old men have been diagnosed with this disease. In any case, a pathology that has such a high incidence and that, therefore, generates a strong impact on the male population, makes it one of the most studied diseases at the urological level and that there are many experts who investigate in the development of new techniques and technologies for its diagnosis and treatment.

Today, the alliance between medicine and technology is critical, as advances in medical devices benefit patients and surgeons. This allows to offer more precise diagnoses and treatments with better results in terms of functional and recovery.

In the words of the doctor Juan Justo Quintas, from ROC Clinic, “technology that demonstrates to improve the diagnostic and therapeutic results of our patients must be incorporated.” And it is that medicine is not exempt from adapting to evolution. As in other sectors, medicine is undergoing a technological revolution of great magnitude.

In this way, advances in techniques for the diagnosis and treatment of prostate cancer are increasing, highlighting, among all, the diagnosis through fusion biopsy, focal therapy and robotic surgery with the Da Vinci robotic system.

Fusion biopsy

Fusion biopsy is, according to ROC Clinic experts, the more accurate and reliable process for detecting prostate cancer. Traditionally, prostate biopsies were performed randomly and blindly, that is, not guided by an imaging test.

With the advent of multiparametric nuclear magnetic resonance imaging of the prostate, this test makes it possible for the first time to see the cancerous area within the prostate. The fusion biopsy allows us to merge the images of this resonance of the patient previously performed with the ultrasound performed in real time in the operating room, allowing to direct the sampling to the region that the radiologist marks as suspicious.

This targeted sampling therefore increases the chance of diagnosing clinically significant prostate cancer, decreasing the chance of leaving a patient actually suffering from the disease undiagnosed. In addition, taking samples through the transperineal route reduces the possibility of infection and eliminates the possibility of rectal bleeding or rectal bleeding.

This type of biopsies, in addition, provides the practitioner with an accurate map of the tumor (size and location) and its relationships with important structures such as the sphincter, which allows the surgeon to better plan the treatment individually and opens the possibility of performing treatments with focal therapy.

Once this biopsy has been analyzed, which accurately provides the extent and aggressiveness of the tumor within the prostate, the surgeon and the medical team, always informing the patient, will decide the best way to intervene and treat this cancer.

Based on this diagnosis, there is a very wide range of therapeutic options, always taking into account important aspects such as age, aggressive characteristics of the tumor, tumor size or volume or location, and depending on that, the best treatment can be adapted. individualized for each patient.

As explained by Dr. Justo, “the options are varied, ranging from not treating the patient and closely monitoring him within an active surveillance program in low-risk cancer patients, to radical treatments, through other options such as focal treatment “.

Treatment with focal therapy

Focal therapy is a minimally invasive treatment, which seeks to replicate the oncological results of radical therapies, reducing the associated side effects such as erectile dysfunction or urinary incontinence.

It consists of treating only the tumor focus, preserving the rest of the prostate gland. For this therapy, it is important to perform a previous fusion biopsy to ensure that the tumor is only in the focus identified in it to perform the treatment. In most cases, it is performed on an outpatient basis or with a short hospital stay allowing a quick return to daily life.

ROC Clinic, for example, has three modalities of focal therapy: cryotherapy, HIFU (high intensity focused ultrasound) and electroporation. Cryotherapy uses low temperatures to destroy cancer cells. Focal therapy with HIFU achieves the same damaging effect on tumor areas, in this case, thanks to the heat concentrated by an ultrasound device.

For its part, electroporation also makes it possible to preserve as much as possible the healthy structures neighboring the tumor lesion to be treated, by administering a series of short, high-voltage electrical pulses that destroy the cancer cells of the lesion to be treated.

Robotic surgery with Da Vinci

Urological interventions have taken a leap in precision by incorporating them into their medical arsenal the Da Vinci robotic system, a device developed in the USA that synthesizes the advantages of open surgery and laparoscopy in a minimally invasive operation.

The Da Vinci robotic system consists of a surgical console, the patient cart with robotic arms, and the vision tower, allowing the urologist to operate remotely and manipulate the optics and arms from the surgical console.

A) Yes, the surgeon has an excellent view of the surgical field, enlarged and in three dimensions, with the possibility of treating anatomical areas that are difficult to access with more precision, which results in better results, and all through accesses of a few millimeters of incision.

In addition to the oncological results, which are the main objective of these surgeries, the use of these robots improves functional results (preserves the sexual function of the male), which influences the improvement of his quality of life.

These surgeries imply less surgical time, less intraoperative bleeding and a hospital discharge in a shorter time space, being, as a whole, a less traumatic intervention and with a less painful and faster post-operative recovery, with a shorter hospitalization and a better and faster return to normal life.

The use of this technology brings more benefits, amplifies the qualities of the doctor, who benefits from a better posture during the intervention, minimizing the fatigue inherent in surgeries of these characteristics. What’s more, it is a secure technology, as it has bidirectional security mechanismsBoth the surgeon on the robot, and the robot on the doctor.

In this sense, for ROC Clinic surgeons, “robotic systems are equipped with security mechanisms so that, in the event of detecting any abnormal action, it stops automatically and activates an alarm, limiting its new start-up to the fact to solve the problem that triggers the alarm “, explains urologist Juan Justo. They also have backup batteries to terminate or remove the robotic system from the patient in cases of power failure.

And although it may seem that machines supplant humans or create barriers between them, in these cases patients are duly informed of the procedure, and once they know its benefits, are prone to these interventions.

According to Dr. Justo’s experience, “the use of robotic technology does not imply a decrease in the attention given to the intervention. The fact of not being in direct contact with the patient does not imply that he is not fully immersed in the surgical procedure that The image quality offered by robotic devices makes the surgery more immersive if possible, as it allows the surgeon to feel that he is navigating inside the patient. “

In any case, the good results of new techniques and technologies, such as the Da Vinci robot, do not prevent technology and medicine from continuing to evolve and improve to provide ever better results in the treatment of prostate and other cancers. of diseases.


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