When prostate cancer is diagnosed early and its growth is slow, treatment may lead to more risks than benefits. In these cases, active surveillance may be recommended.

 
Active surveillance consists of careful monitoring of your cancer. Depending on the patient and the type of tumour, this involves recommended periodic follow-up consultations. During consultations, PSA values and digital rectal examination will be carried out and, if necessary, imaging tests or biopsies may be requested. If the results change, your urologist may recommend starting treatment.
 
Active surveillance is recommended, depending on the age of the patient, when:

• The tumour is small and located in the prostate.
• Its growth is slow.
• It is not causing any symptoms.
• It is associated with low PSA levels (10ng/mL).

Surgery for prostate cancer is radical prostatectomy (RP) and involves removing the prostate gland and some of the surrounding tissue. If the tumour has spread to the lymph nodes, they may also need to be removed.

 
Surgery is a treatment option when the tumour is localised and has not spread outside the prostate.
 

Radiotherapy uses ionising radiation to destroy the tumour. It is a non-invasive and painless treatment that achieves disease control with good results, minimising side effects
 
Radiotherapy with curative intent may be given:
 

• As first line treatment, in localized tumours of either low, intermediate, or high risk.
• In addition to other treatments such as hormone therapy, immunotherapy, or targeted therapy in those patients at higher risk.
• After surgery, in order to eliminate residual disease.

 
In cases where the disease is advanced, radiotherapy may improve symptoms caused by the disease.

Hormone therapy aims to reduce levels of male hormones in the body to prevent these hormones from stimulating the growth of tumour cells.
 
Hormone therapy may be given:
 

• When the cancer has spread to other parts of the body.
• If there is a recurrence and the cancer reappears.
• Together with radiotherapy treatment, when it is a high-risk tumour.
• Before local treatment (radiotherapy or surgery) in order to reduce the size.

 
Types of hormone therapy:

• LHRH analogues. These are drugs that prevent the production of testosterone. They prevent cells in the body from receiving the command to build testosterone.
• Antiandrogens. These are drugs that prevent testosterone from reaching tumour cells.
• Orchidectomy. Surgery removes the lower part of the testicles to prevent them from releasing hormones.

Chemotherapy is used when cancer has spread to other parts of the body and hormone therapy is no longer effective.

Tumour cells produce proteins that prevent the immune system from identifying these cells as abnormal cells and therefore prevent it from attacking them.
 
Immunotherapy blocks the action of these proteins and strengthens the immune system to identify and destroy these cells.
 
Immunotherapy is a treatment option that is currently under investigation (clinical trials) for advanced-stage prostate cancer which is no longer responding to hormone therapy.

Targeted therapy is the basis of precision medicine, this focuses on the study of genetic mutations present in the tumour to be able to deliver precise treatment targeted at the tumour rather than at healthy tissue.
 
In prostate cancer we use gene sequencing tests (NGS) to study for hereditary predisposition, and also to find out if there are defects in DNA repair to assess the possibility of targeted treatment with oral drugs called PARP inhibitors.