Prostate Cancer Treatment

News, Blogs, and White papers

Posted by Dr. Stephen Scionti on Apr 23, 2014 12:24:21 PM

One of the oldest and most respected medical publications is the British weekly journal, The Lancet. With its peer-reviewed articles, it is arguably the finest reporting of evolving medical research and wisdom. To paraphrase an advertising slogan, "When The Lancet speaks, doctors listen."

Significant HIFU news broke in April when The Lancet's Oncology section published a study on High Intensity Focal Ultrasound (HIFU) focal therapy for unifocal (one tumor) and multifocal (more than one tumor) prostate cancer. The distinction is important, because most urologists believe that multifocal prostate cancer automatically defines a patient as NOT a candidate for focal treatment. This study suggests otherwise, and I am pleased that this study validates my own approach to tailoring treatment to the patient.

The study is titled, "Focal Therapy for Localised Unifocal and Multifocal Prostate Cancer: A Prospective Development Study."i Lead author Hashim U. Ahmed (Division of Surgery and Interventional Science, University College London, London, UK) is joined by nine other contributors to the study. Forty-one men were treated with focal HIFU. The follow-up period was 12 months for each patient; at that time, none were incontinent and nine out of ten had no impotence.

The study is part of the ongoing search by England's National Institute for Health and Clinical Excellence for prostate cancer treatments that control cancer while greatly reducing the risk of side effects. Because of this study, the Institute is expected to rule that focal HIFU is safe and effective, and give a green light for larger scale clinical trials. Experts referred to the study's results as very encouraging, and signal the ongoing paradigm shift from whole gland to focal treatment in appropriate patients.

Current treatments include surgery to remove the whole prostate or radiation delivered to the whole gland. Both treatments can effectively treat the cancer, when matched to the proper disease parameters for the patient, but often cause side effects such as incontinence and impotence. However, up to a third of patients have a type of tumor that is unlikely to threaten life by spreading aggressively. Thus, studies like this one report measures aimed at reducing side effects.

The British newspaper The Telegraph ran an April 16 article by Rebecca Smith (Medical Editor) in which she writes, "Focal HIFU involves careful selection of tumours, as small as a grain of rice, within the prostate gland and targeting them with highly focused ultrasound to heat them and destroy them. The advantage over previous HIFU and other treatments is that damage to surrounding tissue is minimised, meaning there are far fewer side effects."ii

Lead author Dr. Ahmed remarked, "This changes the paradigm. By focusing just on the areas of cancer we reduce the collateral damage to surrounding tissue. We're optimistic that men diagnosed with prostate cancer may soon be able to undergo a day case surgical procedure, which can be safely repeated once or twice, to treat their condition with very few side-effects. That could mean a significant improvement in their quality of life."

The full article can be accessed free of charge by registering athttp://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70121-
3/fulltext#article_upsell

ii http://www.telegraph.co.uk/health/healthnews/9206425/New-treatment-for-prostate-cancer-gives-perfect-results-for-nine-in-ten-menresearch.html

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