Prostate Cancer Treatment in Israel

The risk factors for developing prostate cancer include:

• Age: Prostate cancer is uncommon in men under 40 years and is most common in those over 60.
• Family history: There is likely a hereditary link among cases of prostate cancer, particularly with regard to mutations of the BRCA1 gene.
• Race: The rate of prostate cancer is higher in men of African descent than among other races.

Some signs and symptoms of prostate cancer include:

• Blood in the semen or urine, known as hematuria
• Erectile dysfunction
• Changes in urination, including increased frequency, trouble urinating, and pain with urination
• Loss of bladder or bowel control
• Unexplained pain in the ribs, spine, or hips
• Numbness or weakness in the legs

If prostate cancer is not suspected from observed symptoms, it is usually discovered by a prostate-specific antigen (PSA) blood test and/or a digital rectal examination by a physician. Sheba Medical Cancer Center has also made high tech molecular imaging available for our patients as part of our prostate cancer treatment options.

These diagnostic tools go beyond traditional diagnostic imaging techniques that only present a view of the patient’s anatomy, such as CT, MRI, and x-rays. Rather, molecular imaging shows a detailed physiologic picture at the cellular and molecular level. This permits the treatment team to be able to provide tailor-made medicine by offering treatment personalized to the patient’s unique situation.

Molecular imaging allows precise localization of tumors and cancer cells. Furthermore, it shows cellular changes much earlier than they would be detected by older imaging types. Molecular imaging also allows our physicians to quickly determine the exact nature of a patient’s response to treatments like chemotherapy or brachytherapy.

These advanced imaging techniques involve the injection of a radiotracer, a radioactive compound that will bind to certain substances in the body. The radiotracer acts as a sort of highlighter, allowing the amount and locations of these substances to be determined. Molecular imaging is thus part of the discipline known as nuclear medicine.

One type of molecular imaging is positron emission tomography (PET) scans. PET scans are used at Sheba to evaluate the extent and location of the cancer in our prostate cancer patients, as well as patients with other types of cancer. The radioisotope (68Ga) is bound to protein prostate-specific membrane antigen (PSMA), a compound that is often produced in cases of prostate cancer. Once the 68Ga-PSMA is injected into the patient, it begins to decay and emit particles. The PET scanner will detect these particles as “hot spots” or areas of greater concentration.

These hot spots allow the treatment team to determine the exact spread of the cancer, including whether it has infiltrated bones or lymph nodes. 68Ga-PSMA scans are particularly useful when checking for the recurrence of prostate cancer or to survey suspicious lesions, especially when traditional laboratory blood like PSA are normal. 68Ga-PSMA scans can also be utilized when the patient has had a prostatectomy, or surgical removal of the prostate, and other testing methods cannot be used.

Like any nuclear medicine procedure, 68Ga-PSMA scans carry some risk. However, the rate of adverse effects is low, and the benefits outweigh the risks. The scan is performed in a single day and results are available within 24 hours.

68Ga-PSMA is not currently available in the United States. However, over 450 scans have been conducted during the past two years at Sheba. As a result, our staff has gained invaluable experience and expertise in this procedure and we are proud to be able to offer it for our patients when appropriate.

There are several prostate cancer treatments available, depending on the patient’s condition, the stage, extent, and location of cancer, and specific cancer pathology. These may be combined and include:

• Radiotherapy – administered by an external beam of radiation.
• Brachytherapy – a form of internal radiotherapy where small amounts of radioactive material are placed near the location of the cancer
• Chemotherapy – using the latest drugs, including targeted chemotherapy to kill cancer cells while sparing normal cells.
• Hormone therapy – used to decrease the amount of androgens, or male sex hormones, in the patient. As androgens stimulate prostate cancer growth, their reduction can be a key therapy.
• Robotic Surgery – complex surgery whilst using a minimally invasive approach.
• Lutetium-177 PSMA therapy – Prostate-Specific Membrane Antigen Therapy.