What Is Focal Therapy
This novel approach to treating prostate cancer destroys the tumor within the prostate. Not all prostate cancers can be treated safely with focal therapy, and this is an ongoing area of research. We do know that high-quality imaging is critical. By visualizing the tumor with precision on MRI scans or other imaging tests, surgeons can use various sources of energy to get rid of the tumor. These include cryoablation , laser ablation, or high frequency ultrasound. High-intensity frequency ultrasound can also destroy the tumor without harming the prostate.
Focal therapy can successfully remove the prostate cancer without damaging the rest of the prostate gland, thus minimizing the risk of urinary or sexual side effects.
How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:
Top 10 Most Promising Experimental Cancer Treatments
Cancer. A word that fills people with dread. A powerful, devastating word that has destroyed so many lives of cancer victims, their families and loved ones. A word that scientists and doctors are actively and fervently working towards making just a memory.
Every year there are new breakthroughs in oncology research and cancer treatments. Unfortunately a lot of these experimental treatments take years to develop and to run them through the required clinical trials, and they still don’t always pan out in the end. This top ten list, however, is going to walk you through some of the most exciting experimental cancer treatments currently being tested or administered in pre-clinical trials. Scientists are the most hopeful about these experimental cancer treatments right now and explain why they might be viable options for cancer patients. Some of these treatments are still in the early stages of development, whereas others are currently in pre-clinical and clinical trials to test how viable they are as treatments.
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Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the stage of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
Help Getting Through Cancer Treatment
People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.
Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.
Different types of programs and support services may be helpful, and can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.
The American Cancer Society also has programs and services including rides to treatment, lodging, and more to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.
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New Hormone Therapy Drugs
Testosterone drives prostate cancer growth, so medications often target it, says Timothy Daskivich, M.D., urologic oncologist at Cedars-Sinai Cancer in Los Angeles, CA. For many years, patients who progressed on traditional androgen deprivation therapy had few options other than chemo, he says. But new androgen receptor signaling inhibitors can provide excellent cancer control and responses in those patients and have shown improved survival chances in patients with metastatic and castration-sensitive disease when given in conjunction with traditional hormone blockade. These new drugs include abiraterone acetate, apalutamide, enzalutamide, and Orgovyx , the only androgen-deprivation therapy that comes in pill form.
What The Results Showed
What Chesnut and his colleagues wanted to know was if the mens pre-operative findings were consistent with tumor details in their surgically removed prostates. And that turned out to be the case. The men truly did have treatable index lesions without other aggressive cancer, meaning that the biopsy and MRI results had accurately predicted PGA eligibility. Moreover, six additional men were found to be eligible for PGA based on tumor slide analysis, even though the pre-operative and MRI evidence had suggested otherwise.
Given that, the authors concluded that 21 of the initial 77 men, or 27% in all, had recurring prostate cancer that was amenable to PGA.
While the results are promising, the authors also cautioned that, given the small number of men evaluated and other study limitations, they are currently unable to recommend PGA as treatment for recurring prostate cancer outside of clinical trials.
The authors have addressed a very important problem and one that has no easy answers, which is what to do about recurrent or persistent prostate cancer following radiation therapy, says Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org.
About the Author
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
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What Should I Think About When Deciding On Treatment
There are several things to think about when deciding which treatment is right for you. You may want to talk with your doctors about:
- How likely your cancer is to grow, spread, or cause other problems in your lifetime
- Which type of treatment might be best for you
- The trade-offs between possible benefits and possible side effects of the treatments
- Discussing treatment options with your partner or other family members
- How often you will need to see your doctor for treatment
Ask your doctors
- How long may I live with my cancer?
- How likely is my cancer to grow and spread?
- Is watchful waiting or active surveillance an option for me?
- If I use active surveillance, how often should I come in for checkups? What will we do if the cancer starts to grow or spread?
- Which treatment do you think might be best for me based on my age, risk level, and other health issues?
- What is the chance that the treatment might help me to live longer?
- What will my quality of life be with the treatment?
- What side effects of treatment should I watch for and how will they be managed?
- How might treatment affect my sex life?
- If I have surgery to remove my prostate gland, how long might it take to recover?
- Are there local support groups I can join?
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Treating Prostate Cancer That Doesnt Go Away Or Comes Back After Treatment
If your prostate-specific antigen blood level or another test shows that your prostate cancer has not been cured or has come back after the initial treatment, further treatment can often still be helpful. Follow-up treatment will depend on where the cancer is thought to be and what treatment you’ve already had. Imaging tests such as CT, MRI, or bone scans may be done to get a better idea about where the cancer is.
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Emerging Therapies For Prostate Cancer
Researchers are pursuing several new ways to treat advanced prostate cancer. Vaccines that alter the body’s immune system and use genetically modified viruses show the most promise. One vaccine technique works by manipulating blood cells from the patient’s immune system and causing them to attack the prostate cancer.
Blood is drawn from the patient. From the blood sample, cells that are part of the immune system are exposed to cells that make up prostate cancer. Then the blood cells are placed back in the body, with the hope that they will cause other immune system cells to attack the prostate cancer. In a more traditional type of vaccine, the patient is injected with a virus that contains PSA. When the body is exposed to the virus, it becomes sensitized to cells in the body that contain PSA and their immune system attacks them.
Immune or genetic therapy have the potential to deliver more targeted, less invasive treatments for advanced prostate cancer. This would result in fewer side effects and better control of the prostate cancer.
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Endocrine Therapy And Prostate Cancer
Male hormones, specifically testosterone, fuel the growth of prostate cancer. By reducing the amount and activity of testosterone, the growth of advanced prostate cancer is slowed. Hormone therapy, known as androgen ablation or androgen suppression therapy, is the main treatment for advanced prostate cancer. It is the first line of treatment for metastatic prostate cancer.
In many patients, endocrine therapy provides temporary relief of symptoms of advanced prostate cancer. Endocrine therapy may reduce tumor size and levels of prostate specific antigen in most men. PSA is a substance produced by the prostate gland that, when present in excess amounts, signals the presence of prostate cancer.
However, hormone therapy is not without side effects. Some of the more serious side effects include loss of sex drive, impotence, weakened bones , and heart problems.
Eventually, most patients with advanced prostate cancer stop responding to hormone therapy. Doctors call this castrate-resistant prostate cancer.
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British Columbia Specific Information
Prostate cancer is a cancer of the prostate gland, which is a gland that produces the milky liquid found in semen. Patients with low-risk prostate cancer have a 10-year cancer survival rate of over 99%.
You are considered a low-risk patient if you have a PSA value that is equal or less than 10 nanograms per millilitre , a Gleason score that is equal or less than 6, and your cancer stage is T1c/T2a. PSA is your prostate specific antigen measured by a blood test, the Gleason score indicates how aggressive the cancer is by looking at tissue biopsy results, and the cancer stage describes how much the cancer has spread.
Active surveillance has been developed to allow for careful management of men with low-risk prostate cancer. For more information, visit BC Cancer Agency â Prostate.
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An Emerging Treatment Option For Men With Recurring Prostate Cancer After Radiation Therapy
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Prostate cancer is often a multifocal disease, meaning that several tumors can be present in different parts of gland at the same time. Not all of these tumors are equally problematic, however. And its increasingly thought that the tumor with the most aggressive features called the index lesion dictates how a mans cancer is likely to behave overall. That concept has given rise to a new treatment option. Called partial gland ablation , and also focal therapy, it entails treating only the index lesion and its surrounding tissues, instead of removing the prostate surgically or treating the whole gland in other ways. Emerging evidence suggests that PGA controls prostate cancer effectively, but with fewer complications such as incontinence.
In February, researchers at Memorial Sloan Kettering Cancer Center in New York published findings that could pave the way for focal therapy in men with reoccurring prostate cancer. They focused specifically on men whose cancer had returned three to four years on average after initial treatment with radiation.
Their findings, while preliminary, suggest that MRI and biopsy results can allow doctors to select which patients with reoccurring prostate cancer might be eligible for PGA. The research was headed by Dr. Gregory Chesnut, an MSKCC urologist.
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Improvements For Localized Cancers
There have been breakthroughs in the treatment of earlier-stage prostate cancers, too, which help to reduce the number of advanced cases in the long run. With respect to localized prostate cancer, one significant development has been the advent and expansion of active surveillance as a treatment option for men with low-risk prostate cancer, explains Dr. Haywood. For men with low-risk and very-low risk prostate cancer, this strategy avoids side effects of prostate cancer treatment while maintaining the ability to deliver definitive therapy when conditions dictate.
Your Prostate Cancer Treatment Plan
At Henry Ford, we are leaders in the field of prostate cancer therapies and prostate tumor surgery, offering:
- Unmatched experience in innovative and minimally invasive prostate cancer surgery, including single-port robotic surgery for greater precision and shorter recovery times
- World-first MRI-guided radiation therapy that combines advanced technology with real-time tumor imaging to deliver accurate, precise treatment
- Non-invasive prostate cancer treatment, including cryotherapy, for men with localized prostate cancer
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Is There Anything Else You Feel Urologists Should Know About This Topic
It’s probably also worth mentioning that all the clinical trials that I was describing use lutetium PSMA 617, which is the Novartis product. There is another product in active development called lutetium PSMA INT, which is very, very similar, has some minor differences, and there are a few companies around the world commercializing lutetium PSMA INT. There other groups working on next-generation targeting molecules. So, they’re the 2 first cabs off the rank, and now we’ll have a newer generation. Can we improve targeting by modifying the PSMA targeting molecule further?
Another way we’re trying to improve this treatment is by using different radioactive substances other than lutetium 177. There’s a lot of interest in actinium 225, which is an alpha emitter, a different type of radioactive substance. And there’s a whole myriad of different radioactive substances that can be used that are going to be evaluated over the next few years. I think this is going to be an area of really explosive growth and interest, but most importantly, a new treatment option to both improve survival and improve quality of life for men with prostate cancer.
References
1. Hofman. PSMA Theranostics: The New Age of Prostate Cancer Imaging and Treatment. Lecture presented at: 2021 Prostate Cancer Foundation Scientific Retreat October 28-29 and November 4-5, 2021 Virtual.
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Do We Know Which Treatment Is Better For Prostate Cancer Brachytherapy Or External Beam Radiation
Its not a question of which therapy is better but rather which therapy is the most tailored, pinpointed radiation for the patients specific disease.
When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level or the Gleason score or visible evidence of disease on an MRI we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best.
Data that we have published recently show that for patients with intermediate-risk disease, the combination of external beam radiation with brachytherapy not only provides better biochemical control, in terms of PSA level, but also reduces the risk of distant metastases, or spread of the disease. Another recent study from Canada, which compared outcomes in patients who were treated with external beam radiation or a combination approach, found superior results when the combined approach was used. These studies provide strong evidence that higher doses of radiation provide an important benefit to patients with intermediate-risk and high-risk prostate cancers.
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New Therapy For Aggressive Prostate Cancer Improves Survival
The experimental treatment relies on radioactive molecules that seek out tumor cells, a strategy that may be useful against other cancers.
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An experimental therapy has prolonged life in men with aggressive prostate cancer that has resisted other treatments, offering new hope to patients with advanced illness and opening the door to a promising new form of cancer therapy.
Among men who received the new therapy, there was a nearly 40 percent reduction in deaths over the course of the clinical trial, compared with similar patients who received only standard treatment, researchers reported on Wednesday.
Prostate cancer is the second-leading cause of cancer death among American men, after lung cancer an estimated 34,130 men will die of prostate cancer this year. One in eight men will be diagnosed with the disease at some point in their lives. The risk increases with age, and the cancer is more common in Black men.
The new treatment relies on a radioactive molecule to target a protein found on the surface of prostate cancer cells. The study, which followed 831 patients with advanced disease in 10 countries for a median period of 20 months, was published in The New England Journal of Medicine.