Prostate Cancer Treatments in 2026

Minimally Invasive Treatments for Prostate Cancer

Steen Rees

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A review of the latest minimally invasive treatments for prostate cancer

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Prostate cancer has become a very, very common cancer. Indeed, it's the commonest male cancer. And I think when you're making a choice between all the different treatment options, you need to be aware that there's a lot of minimally invasive options that are now available to you. And you need to really think about those and make sure that you've considered them all. Those minimally invasive options are firstly robotic keyhole surgery to remove the prostate. Secondly, low dose rate brachytherapy to minimally irradiate the prostate. Thirdly, even active surveillance, just monitoring the prostate. Fourthly, focal therapy, where you treat only a section of the prostate. And finally, newer technologies such as tulsa, which minimally invasively treat the whole prostate. Now, radiotherapists have also brought in a new minimally invasive treatment called MR Linac, which is radiation inside an MRI machine. Now, all of these options may be suitable for you, but you need to understand them. So if I just expand minimally on them, then you can do the rest in terms of researching them and getting much more detail and speaking to different people about them. So let's start with simple active surveillance. Active surveillance means that you've been diagnosed with an early non-life-threatening cancer which can be monitored. Now the monitoring process may be six monthly blood tests, an MRI every year or two, and a biopsy every four or five years. Now this is just keeping an eye on something which is not likely to cause a problem. Another minimally invasive treatment is brachytherapy or MR linac radiotherapy. These are two forms of radiotherapy. Brachytherapy has been around for 30, 40 years, and MR Linac radiotherapy, which is radiotherapy inside an MRI machine, improving accuracy, has only been around for five years. Now these less invasive radiotherapy techniques avoid collateral damage. Now what does that mean? It means that the old days of damaging your rectum are gone. It also means that we can try and tailor it to get rid of cancers by increasing the dose of radiation to that cancer. Now, not everybody has these and not everybody has the expertise, but you need to be aware that they're around and that they are a potential option. As with all radiotherapy options, there are downsides of them down the track, such as you can't then fall back on surgery. And another problem that we've got is that they can cause cancer in adjacent organs. So you need to bring those topics up with your radiation specialist. Another option which is minimally invasive is focal therapy. I've been quite passionate about this for the last 13 years, and the technique that I've used has been irreversible electroparation, or what's commonly known as nanonyme. I've done almost 800 of these now, and the advantage of focal therapy as a group is that it causes minimal damage and has minimal effect on quality of life, such as urinary control and erectile functioning. The disadvantage is that it doesn't treat the whole prostate, so it means ongoing monitoring. And it doesn't have quite the track record of surgery and radiotherapy because it's only been followed for 10 to 15 years so far. But it's worth considering if you happen to be a suitable candidate and everything lines up, such as the MRI, PSMA, and biopsies, that you've got a localized intermediate risk prostate cancer. Finally, there are new minimally invasive treatments on the horizon, and one of them is called Tulsa, T U L S A. It's a transurethral, high-intensity focused ultrasound inside an MRI machine to destroy the prostate and minimize the chance of erection problems and incontinence. It's quite new, doesn't have a long track record, but it is undergoing fairly vigorous trials at the moment worldwide. And I've been impressed with the early results and am cautiously introducing it in Australia. I think this is also something you need to keep on your radar. And if you're a person who simply will not accept surgery or radiotherapy, but you've got multifocal intermediate risk cancer, this may be an option for you. So minimally invasive treatments for prostate cancer are becoming commoner and commoner. And as a result, I think you need to be aware of them and consider them and to find out whether you're suitable. And if you are suitable, then maybe even go to the most experienced person who may offer them.