After skin cancer, prostate cancer is the most common cancer in men in the U.S. The good news is that if cancer is detected in its early phase, the chance of curing it is very high. Screening men for prostate cancer has resulted in men being diagnosed considerably earlier in the disease process, which has improved mortality rates from by over 30%, which is an astounding number in cancer therapies.
The Most Common Prostate Cancer Therapies
To date, men have been treated in one of three ways (mainly):
Active Surveillance
If the disease is minuscule and non-aggressive, it can sometimes be observed. With active surveillance, a patient is monitored closely, with repeat prostate biopsies and when cancer becomes more aggressive or larger in volume, then the patient undergoes surgical removal of his entire prostate or the entire gland is radiated.
One problem with active surveillance is that the cancer at the time of the initial diagnosis may be more aggressive than the initial biopsy indicated (this is, in fact, the case in over 40% of men!!) or larger in volume than what the physician believes the tumor size to be. Therefore, a considerable number of men on active surveillance are getting delayed therapy–in fact, over 10% of men on active surveillance who finally undergo treatment find that their cancer has already spread outside the prostate gland and that they waited too long.
Prostatectomy
Many men who have prostate cancer ultimately undergo a surgery called a prostatectomy. This surgery is an excellent option for men, However, it has significant risks including erectile dysfunction (30-70% of men) and loss of urinary control (10-15%). The change in a man’s quality of life after surgery can, therefore, be significant and life altering. In most cases, a prostatectomy is reserved as a last option for treatment when conservative modalities have failed.
Radiation
Men that do not undergo surgery typically undergo radiation to the prostate. With this approach, the entire prostate is radiated (typically over an eight-week course). While radiation therapy can also be effective, it also has significant risks, including a 50-60% chance of developing erectile dysfunction as well as a small risk of developing a secondary bladder or rectal cancer.
With both surgery and radiation, the entire prostate is treated regardless of the extent and location of the cancerous cells.
Advances in Prostate Cancer Treatments
Let’s learn something from women and breast cancer. 50 years ago, a woman diagnosed with breast cancer would have had her entire breast removed. Today, though, most women only have the cancerous tissue removed (a lumpectomy) and the normal breast tissue is preserved.
To date, a “prostate lumpectomy” has not been available because of two reasons:
- We have not had reliable imaging or prostate mapping to confidently identify the location and extent of the prostate cancer, and
- We have not had a treatment modality that can reliably and accurately treat just the area of interest.
Well, both of these issues have now been resolved. Using special MRIs (called multi-parametric MRI of the prostate) and new biopsy mapping techniques, we can accurately diagnose the location and extent of prostate cancers in men.
What is High Intensity Focused Ultrasound?
Using a new treatment modality called HIFU (High Intensity Focused Ultrasound), we can now utilize harmless ultrasound waves with great precision to destroy malignant cells within the prostate while preserving the normal tissue as well as the structures around the gland that control a man’s erectile function and urinary control. With HIFU we can now provide focal therapy (the “prostate lumpectomy”) and preserve a man’s normal erectile function and urinary control (the risk of erectile dysfunction with focal HIFU therapy is as little as 5% and the risk of loss of urinary control is about 2%).
However, not all men are candidates for HIFU therapy (depending on the size and anatomy of their prostate and the extent of their cancer). Undoubtedly, HIFU will revolutionize prostate cancer therapy in the immediate and near future.
Schedule a HIFU Consultation at Comprehensive Urology
If you or a loved one has been diagnosed with prostate cancer or is interested in cancer screening, please do not hesitate to contact Comprehensive Urology for an appointment. Our team is dedicated to providing the best care and treatment for each patient depending on his unique needs. Learn whether you are a candidate for HIFU treatment by calling 310.499.2756 today.
Next, read Why You Should Consider da Vinci Robot Prostatectomy