Contributed by Dr. Michael Wolff
Since most prostate cancers are diagnosed early, making a decision about which prostate cancer treatment option to move forward with can be extremely confusing. Localized, early-stage prostate cancer that is considered low grade, can be treated in a lot of different ways. With many different viable treatment options, it becomes difficult to understand what the drawbacks and benefits of each may be. The good news is that with this type of diagnosis, there is a lot of research available to help you understand various outcome statistics in order to determine what is most important to you.
If you are focused on your biochemical disease free survival rate, or the chance you will not have cancer after your procedure is complete, most therapy options are very effective:
- HIFU (Focal Gland): 83%1
- HIFU (Full Gland): 83%2
- Radical Prostatectomy (Robotic): 80%3
- IMRT: 81%4
However, in addition to making sure they are cancer-free, most men are equally, if not more, concerned about maintaining their quality of life after prostate cancer treatment. Almost every patient I encounter asks me some version of the following question, “Will I regain the same erection and urinary function I had before my procedure?” Basically they want to know if the procedures cause side effects that cause problems with their ability to urinate (or stay dry) or their sex life.
This is where things get a lot more complicated. The types of side effects and the potential risk of those side effects vary greatly between the various treatment options, and a patient’s individual diagnosis. Impotency rates, or lack of erection sufficient for penetration, can range from the following:
- HIFU (Focal Gland): 11%1
- HIFU (Full Gland): 24%2
- Radical Prostatectomy: 87%5
- Radiation Therapy: 93.9%5
Incontinence rates, or urinary leakage, amongst the different treatment options can range from:
- HIFU (Focal Gland): 0%1
- HIFU (Full Gland): 0.6%6
- Radical Prostatectomy: 18.3%5
- Radiation Therapy: 9.4%5
There are obviously many more options than the ones presented here, but this is a quick snapshot that compares HIFU with some of the traditional treatment options. The best advice I can give is to to do your own research and make a list of questions for your doctor. Be prepared to ask about his unique experience with specific treatments; with a lot of procedures, experience really matters. Also, speak with other men who have had various treatments. A prostate cancer survivor’s experience will give you an unique and important perspective.
- Ahmed, HU. (2012). The Lancet Oncology. Focal Therapy for Localized Unifocal and Multifocal Prostate Cancer: A Prospective Development Study, 2045(12), 70121-3.
- Uchida, T. (2012). 11th International Symposium on Therapeutic Ultrasound. AIP Conf. Proc. Twelve Years’ Experience with High-Intensity Focused Ultrasound (HIFU) Using Sonablate Devices for the Treatment of Localized Prostate Cancer. 1481, 401-406.
- Novara, G. (2012). European Urology. Systematic Review and Meta-analysis of Studies Reporting Oncologic Outcome After Robot-assisted radical Prostatectomy. 62, 382-404.
- Alicikus, Z. (2011). Cancer. Ten-Year Outcomes of High-Dose Intensity-Modulated Radiotherapy for Localized Prostate Cancer. 1429-1437.
- Resnick, M. (2013). The New England Journal of Medicine. Long-Term Functional Outcomes after Treatment for Localized Prostate Cancer. 368, 436-45.
- Ahmed, HU. (2009). BJC. High-intensity-focused ultrasound in the treatment of primary prostate cancer: the first UK series, 101, 19-26.
About the Author
Dr. Michael Wolff is the leading minimally invasive prostate cancer physicians in the North Carolina Triad area. Dr. Wolff was an early adopter of HIFU and treated his first patient 2007, and has treated over 100 patients since being trained. Dr. Wolff is now thought of as one of the Carolinas regions most experienced HIFU physicians and proctors.
Dr. Wolff was also one of the innovators in focal therapy and was one of the first in the Carolinas to treat prostate cancer focally using HIFU. Because of Dr. Wolff’s vast HIFU experience, he has assisted in training other physicians from across the country in the use of HIFU for treating prostate cancer.