Prostate oncology

As with other high-incidence cancers, the EOC model of care in the care of the prostate cancer patient is the Specialty Oncology Centers (COS), the most modern and effective response to cancer disease.

The Oncology Center

Centers of expertise structured by organ, EOCs organize and optimize the care of the patient with cancer disease in a multidisciplinary and interprofessional care network. The model involves the cross-disciplinary and coordinated involvement of professionals with complementary specialties, the centralization of highly specialized services, and an accompanying service to treatment and recovery in all EOC hospitals.

Thanks to this model of care, EOC offers all Ticino patients up-to-date treatment protocols on the highest international standards and access to the best diagnostic, therapeutic and care pathway.

Prostate cancer: originates from the uncontrolled growth of cells within it. There are several types of cells in the prostate, each of which can transform and become cancerous; almost all diagnosed prostate cancers originate from glandular cells and are consequently called adenocarcinomas. More rarely, sarcomas, small cell carcinomas, and transitional cell carcinomas, which have different biological behavior and treatment than adenocarcinomas, may also arise in the prostate.

Prostate cancer and early diagnosis

The prostate is a gland in the male genital system, and participates along with the seminal vesicles in the production of seminal fluid. Similar in shape and size to a chestnut, it is located below the bladder to surround the posterior urethra, and anterior to the rectum, through which it can be appreciated by digital palpation.

The incidence of prostate cancer, i.e., the number of newly diagnosed cases, is steadily increasing due to the rise in the average age of the general population and the increased use of tests that allow for its early diagnosis, particularly the PSA (prostate-specific antigen) test.

Diagnosis

The diagnosis of prostate neoplasia is a process that occurs through several steps, from initial evaluation to advanced diagnostic assessment, which include:

• Clinical examination with digital rectal exploration.
• Blood draw for prostate-specific antigen (PSA) assay: PSA is a glycoprotein produced by the prostate gland that serves to thin seminal fluid. An increase in PSA in the blood can be an indicator of a pathological process affecting the prostate, not necessarily cancerous, such as in cases of prostatitis, benign prostatic hypertrophy, or following trauma; in oncology, PSA is also used to monitor tumor response to therapies given.
• Multiparametric magnetic resonance imaging: in cases of clinical doubt, it is the best radiology-type method for evaluating the prostate gland. It allows mapping of the prostate allowing subsequent targeted biopsy (fusion prostate biopsy) of any suspicious lesions within it. It also allows useful information to be obtained on the status of the surrounding organs (pelvic lymph nodes and pelvic bones).
• Ultrasound-guided prostate biopsy with "fusion" technique: allows small samples of prostate tissue (frustules) to be taken by exploiting information from MRI. The samples taken are then analyzed under a microscope to detect the presence of cancerous cells. It represents the pivotal moment in the diagnosis of prostate neoplasia.

In order to determine the staging of prostate cancer (i.e., to determine whether the disease is localized within the prostate or more extensive) and to assess the response to applied therapies, instrumental examinations such as:

• CT scan: a diagnostic imaging method that uses X-rays to search for metastases, i.e., localizations of prostate cancer outside the gland in distant organs.
• Bone scintigraphy: a nuclear medicine method that is used to search for possible skeletal metastases.
• PSMA PET: is a sophisticated nuclear medicine method that provides greater sensitivity and accuracy in staging prostate pathology and searching for disease recurrence after surgery or radiotherapy. PSMA is a prostate-specific membrane antigen, present in large amounts on the surface of prostate cancer cells, and is therefore an ideal marker to search for the presence of the neoplasm within the body.

Treatments

The treatment of prostate cancer, similar to other types of cancer, may be through different methodologies, or the combined action of the same.

• In selected cases, when the risk of progression is very low, a rigorous monitoring program, called "active surveillance," may be offered to patients, postponing treatment until the disease changes its initial characteristics, keeping the probability of cure high and avoiding the potential side effects of treatments for the patient.
• Urological surgery: robotic radical prostatectomy is a surgical procedure performed under general anesthesia that allows removal of the prostate with minimally invasive access. The DaVinci robot makes it possible to offer the patient a reduction in blood loss during surgery and, consequently, hemotransfusions. In the postoperative period, the robotic approach reduces pain, hospital stay time, and allows faster resumption of daily activities.
• Radio-oncology: radiotherapy, possibly combined with hormone therapy and hyperthermia, uses high-energy ionizing radiation to "destroy" cancer cells while trying to safeguard surrounding healthy tissues and organs. It is an outpatient treatment and involves no invasive procedures. It can have several purposes:
  • Curative intent: it is performed for the purpose of radically eliminating all cancer cells in the prostate and/or pelvic lymph nodes.
  • Postoperative (adjuvant) intent: is performed within a few months after prostatectomy surgery to eliminate any remaining cancer cells and reduce the risk of local recurrence.
  • Postoperative salvage intent: is performed after surgery only in case of PSA rise and/or in case of recurrence;
  • Palliative intent: is performed in patients in whom the disease has spread to other organs. Palliative treatment can also be performed on the prostate when the disease is locally extensive and may condition local compression/infiltration symptoms of neighboring organs (bladder, rectum).
• Medical oncology: evaluates the indication for systemic anticancer treatments of various types (androgen deprivation hormone therapy, new generation hormone therapies, chemotherapy, biologic or target therapies, radiopharmaceuticals such as Radium-223 and Lutetium-PSMA), always taking into account the characteristics of the individual patient and the potential side effects of these drugs. These therapies have different indications for the treatment of prostate cancer depending on the disease context:
  • In localized disease: the addition of short-term or long-term (up to 3 years) hormone therapy in combination with curative-dose radiation therapy is intended to reduce the risk of disease recurrence.
  • In metastatic disease: androgen deprivation hormone therapy forms the basis of treatment by slowing the progression of cancer cells at metastatic sites (typically bone and lymph nodes). In this disease setting, adding chemotherapy and/or next-generation hormone therapy to androgen deprivation therapy has been shown to result in improved survival. The androgen deprivation strategy is frequently accompanied by side effects such as hot flashes, sexual impotence, fatigue, osteoporosis, and metabolic syndrome: the patient is constantly monitored, informed of these possible side effects, and helped in management.

The choice of treatments should be shared with the patient taking into account disease characteristics, comorbidities but also the patient's desire. An important element to be taken into consideration in the choice of treatment is to ensure that each patient has the best possible quality of life since, thanks to the oncological treatments available today, it is possible in many cases to chronicize this disease.

Managing the return home

Useful information for patients returning home following prostatectomy surgery.

A key role for information and awareness

The Prostate Center of the Italian-speaking part of Switzerland channels interdisciplinary expertise into a single organizational platform to best follow the patient on his or her journey. It is also available for those who need information, clarifications and explanations regarding issues related to prostate cancer, as well as to raise awareness and inform the public about the issue.

Quality and safety of care

Multidisciplinary meetings, adherence to guidelines, internal and external quality audits ensure the quality and safety of care provided.

Multidisciplinary meetings
Multidisciplinary meetings or multi-disciplinary meetings (MDMs) are a tool developed to further ensure the quality and safety of care offered. In addition to being one of the mandatory requirements for certification, multidisciplinary meetings are intended to ensure that patients have access to the best treatment decisions through the involvement of multiple specialists in the definition and management of pre- and post-operative care.

Certifications

Certified European Prostate Cancer Centre
In 2021, the Prostate Center of Italian Switzerland was awarded the "Certified European Prostate Cancer Centre" certificate by Onkozert of the Deutschen Krebsgesellschaft (DKG). The Certificate is awarded based on adherence to requirements set by international guidelines, and confirms that the therapeutic offering corresponds to the quality, practices and methodologies defined by international experts.

Cancer League Ticino

In the field of prostate oncology, the collaboration with the Cancer League Ticino provides patients with specialized counseling in the social and intensive oncological rehabilitation fields, offering patients and family members advice and support in administrative, financial and other areas.

Through its regional offices (Bellinzona, Locarno, Lugano, Mendrisio), the League is available to all patients and family members for counseling in the social, psychological and rehabilitation fields.

More information is available at the website or by calling 091 820 64 20. Also available is the Cancer Info hotline on 0800 11 88 11 where a nurse with a specialization in the oncology area answers questions from patients and family members in the three national languages.

The League also supports cancer research, offers prevention information campaigns and supports the self-help association PROCASI.

PROCASES

Collaboration with PROCASI - Association of the Italian-speaking part of Switzerland for information on prostate cancer and support for people affected by it - is also active. Among the activities carried out by the Association are presented online thematic meetings to which patients, family members, friends and people interested in the topic are invited.
For more information visit.

Clinical manager

Doctors on the surgical core team