Prostate cancer is one of the most commonly diagnosed cancers in men, and understanding the available treatment options is an important first step for anyone facing a diagnosis, whether it’s for yourself or loved one. The treatment approach for prostate cancer varies significantly depending on its stage and progression, making it essential to understand the difference between localised and advanced forms of the disease.

Localised prostate cancer refers to cancer that remains confined within the prostate gland. It has not spread to nearby tissues, lymph nodes, or other parts of the body, and is often detected early through PSA (prostate-specific antigen) blood tests. In contrast, advanced prostate cancer has spread beyond the prostate, potentially affecting nearby tissues, lymph nodes, or distant organs such as the bones, liver, or lungs. The stage of the cancer significantly impacts the treatment options and prognosis.

At our urology clinic in Auckland, Dr. Imran Ali specialises in men’s health, offering advanced treatments for certain stages of prostate cancer. 

In this article, we explain the main treatment options for prostate cancer, including active surveillance, robotic surgery, radiation therapy, and NanoKnife technology.

 

Active Surveillance

For men with low-risk, slow-growing localised prostate cancer, Active Surveillance can be a suitable treatment approach. It involves regular monitoring through PSA tests, digital rectal exams (DRE), and imaging scans to closely track the condition. This strategy prioritises careful observation over immediate intervention, helping to avoid unnecessary treatments and their potential side effects in the early stages of the disease.

While effective for managing low-grade prostate cancer, Active Surveillance requires consistent follow-ups and diligent monitoring to detect any signs of progression. For many patients, it offers a way to minimise the risks associated with more invasive treatments. If the cancer shows signs of progression during Active Surveillance, other treatment options will then be considered.

 

Robotic surgery or prostatectomy

Surgical removal of the prostate gland, known as a prostatectomy, is a common treatment option for men with localised prostate cancer. Often performed using robotic-assisted techniques that are minimally invasive (key hole), this method allows for greater precision and typically results in quicker recovery times compared to traditional open surgery.

This option is most suitable for men whose cancer is confined to the prostate and who are in good overall health. Surgery is particularly effective for completely removing cancer in its early stages. 

However, it is important to consider the potential side effects, which may include urinary incontinence and erectile dysfunction. The prostate gland is small and surrounded by delicate critical tissues, such as nerves and blood vessels that control urinary and sexual functions. The proximity of these vital components can make it challenging to surgically target cancer cells without affecting healthy tissue, increasing the risk of side effects like incontinence and erectile dysfunction.

Dr. Imran Ali provides personalised consultations to help patients understand their surgical options, including the potential benefits of nerve-sparing techniques to preserve function where possible.

 

Radiation therapy

Radiation therapy is a non-surgical treatment that uses high-energy rays or particles to target and destroy cancer cells. It is an effective option for both localised and advanced prostate cancer, offering flexibility for patients at different stages of the disease.

Radiation therapy is especially valuable for men who may not be candidates for surgery or who prefer a less invasive approach. While generally well-tolerated, side effects may include bowel and bladder issues, as well as fatigue. Despite these considerations, radiation therapy remains a cornerstone of prostate cancer treatment and is a powerful tool for managing the disease.

 

NanoKnife: A minimally invasive alternative for some types of prostate cancer

The NanoKnife procedure is a modern, minimally invasive treatment designed for certain types of localised prostate cancer. This innovative technique uses electrical currents called Irreversible Electroporation (IRE) which targets and destroys specific areas of cancerous tissue while preserving the surrounding healthy tissue. These invisible electrical currents create tiny holes in the cancer cell membranes, disrupting their ability to function and survive. This causes the cells to die in a controlled manner, known as apoptosis (a natural process of cell death).

Once the cancer cells die, the body’s immune system steps in to clean up. Immune cells, such as macrophages, identify the damaged or dead cells as waste and break them down into smaller components.

The debris from the broken-down cancer cells is transported away from the treatment site within the body through natural mechanisms, including the bloodstream (where cellular debris is filtered out by the liver and kidneys) and the lymphatic system (which helps remove excess fluids and waste).

Over time, the treated area in the prostate heals, and healthy surrounding tissue is preserved, as NanoKnife specifically targets the cancerous cells while sparing nearby structures. It’s remarkable!

NanoKnife offers a targeted approach and is performed as a day surgery, allowing for reduced recovery times and a significantly lower risk of side effects compared to robotic surgery or radiotherapy. Patients who undergo NanoKnife treatment often experience fewer complications, such as incontinence or impotence, making it an appealing option for those seeking effective yet minimally invasive care.

NanoKnife is most suitable for men who meet specific medical criteria. Here’s a simplified explanation of who might be eligible for this procedure:

1. Localised prostate cancer
   NanoKnife is best suited for men with localised prostate cancer, where the tumour is confined to the prostate gland. The cancer should not have spread beyond the affected area or to the other side of the prostate.
2. Tumour characteristics
   Candidates typically have a low to moderate risk of prostate cancer. This includes:
   • Prostate cancer with a Gleason score of 6 but involving a significant portion of the prostate.
   • Low- to moderate-grade prostate cancer with a Gleason score of 7, particularly if the higher-risk component is minimal.
3. PSA levels and tumour identification
   A PSA (prostate-specific antigen) level of less than 15 is required. Additionally, the tumour must be clearly visible on an MRI scan, and ideally a PSMA PET CT scan, and the results must match the findings of a targeted biopsy.
4. Exclusion of other significant cancer
   Before proceeding with NanoKnife, template biopsies are performed to ensure there is no significant cancer outside the affected area or on the opposite side of the prostate.
5. Patient preferences
   NanoKnife is a suitable option for men who do not wish to pursue standard therapies like surgery or radiotherapy. 
6. Commitment to monitoring
   Patients must accept the need for ongoing monitoring after treatment, including regular check-ups to ensure the cancer remains under control.

At our clinic, we are proud to be the first in New Zealand to offer this advanced procedure. To learn more about the NanoKnife procedure, visit our NanoKnife information page.

Prostate cancer is a complex condition, and we believe that understanding the disease is one of the important steps in managing it. By learning about the differences between localised and advanced prostate cancer, you can make informed decisions about the treatment that’s best for you. With advancements in medical technology, there are now more choices than ever, including options like NanoKnife, which offers a minimally invasive approach for certain patients.

At our urology clinic in Auckland, we take pride in providing personalised care tailored to each patient’s unique needs. Our goal is to help our patients achieve the best possible outcome while maintaining your quality of life.

If you or a loved one is facing a prostate cancer diagnosis, we’re here to support you. Please feel free to reach out to discuss your concerns, explore your treatment options, and create a plan that works for you. Together, we can navigate this journey with confidence and care.

Contact us today to learn more or to book a consultation.