Part I – Contemporary Management of Prostate Cancer

The Problem with how Prostate Cancer is Managed

The problem with how prostate cancer is managedProstate cancer is the leading non-skin cancer in men. In 2017, there were 162,000 new cases of prostate cancer and approximately 27,000 men died from the disease (according to American Cancer Society). There are different grades and stages of prostate cancer and some men, diagnosed early with low-grade disease, can live with it. This is typically the case with men who have what is referred to as a Gleason grade 6 (3+3). However, there is controversy about this and a Gleason 6 has been known to spread (metastasize) to other areas of the body. This clearly is an indication that even low-grade disease has the potential to be aggressive and do great harm to some of those who have it.

Here is the problem with the management of prostate cancer: when men are diagnosed with a Gleason 7 or higher, the treatment that follows is usually radical prostatectomy or radiation therapy if the disease is confined (localized) to the prostate.

However, for those patients, there may be better – less invasive options.  In fact, there are therapies that are relatively new in the United States but have been used in other parts of the world for 15 or more years, that show promising results for eliminating cancer and minimizing common side effects such as impotence and incontinence. One of these treatments is called, HIFU, or high intensity focused ultrasound.

Why is HIFU an important addition to our prostate cancer treatment options?

In order to fully understand its importance, we have to the aforementioned traditional treatments for prostate cancer. The radical prostatectomy is frequently associated with significant side effects. What are they? Urinary incontinence, the loss of bladder control, can be as high as 30-80 percent. In some cases, this means leaking all the time, in other cases it means leaking when coughing, laughing sneezing or doing any strenuous activity. The other major problem is surgery can rob men of their sexual function by causing erectile dysfunction or ED. Some peer-reviewed literature reports that ED as high as 50-80 percent. While these conditions can be treated, they are rarely cured and many prostate cancer patients deal with these types of problems for the rest of their lives.

Now let’s go back to HIFU. When men who are diagnosed early have HIFU, they can often avoid problems like impotence and incontinence all together AND cure their cancer. Some readers may remember the United States Preventative Service Task Force (USPSTF) back in 2012 that recommended against routine prostate-specific antigen (PSA) tests to screen for prostate cancer in healthy men. At the time, this was a very controversial recommendation that the USPSTF eventually rolled back in 2017 for men aged 55-69 saying instead that men should talk with their doctor and each person make their own individual decision as to whether or not regular screening is right for them. However, during the five years that the recommendation was in place, some research shows that prostate cancer went undetected or was diagnosed at a more advanced stage due to lack of regular screening.

Now with the PSA test more widely available for most men and MRI-guided biopsy, it is easier for physicians to catch and diagnosis prostate cancer early.

When prostate cancer is diagnosed early, men have lots of different treatment options to choose from, including HIFU, which is an outpatient, one-time treatment that allows men to return to their normal lifestyle within a few days. It is not uncommon for a man treated with HIFU in the morning to go out and have a regular dinner in a restaurant that very same evening. He can easily maintain himself at home or in a hotel and can even drive a car the day or two after the treatment and return to work within one week. HIFU has the ability to preserve both urinary and sexual function, two of the major side effects of traditional prostate cancer treatments.

Article contributed by: Dr. Herb Reimenschneider

Coming Soon: Part II –  If HIFU is So Great, Why Haven’t You Heard More About It?

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