What Can Be Expected After Treatment Using Focal Therapy
Patients treated with focal therapy still need to be actively monitored afterwards. This includes watching for disease that may have gone undetected, has returned, is spreading, or is appearing for the first time. If follow-up tests show that some of the treated cancer still remains, additional ablation, surgery, or radiation may be needed.
Prostate Cancer Patients Are Paying Hefty Price For Controversial New Treatment
Men hoping to avoid some side effects of prostate cancer treatment are shelling out tens of thousands of dollars for a procedure whose long-term effects are unknown and insurers, including Medicare, wont pay for.
Proponents say high-intensity focused ultrasound can have fewer negative side effects than surgery or radiation, while giving some patients another option between actively watching their cancer and those more aggressive steps. Critics, however, say the procedure is being oversold, leading some patients to get a treatment they dont need.
Device makers are busy selling the $500,000-and-up machines to doctors around the country and offering training courses. Billboards advertising this new non-invasive treatment for prostate cancer are springing up, while treatment center websites promise a safer method with benefits such as no erectile dysfunction and no incontinence, although studies show those side effects can occur, but less often than with other types of more aggressive treatments. The treatment can range in cost from $15,000 to $25,000.
HIFU is the latest treatment to prompt concerns over whether there should be limits such as requiring tracking of results placed on expensive new technology while additional data is gathered.
In the U.S., advisory committees to the Food and Drug Administration twice turned down applications from manufacturers to market HIFU devices as a treatment for prostate cancer, citing not enough long-term evidence.
What Is Focal Therapy For Localized Prostate Cancer
Focal therapy is a treatment for prostate cancer of low to intermediate aggressiveness that is completely contained within the prostate.
For many years there have been two main approaches to managing localized prostate cancer. The first is active surveillance or watchful waiting. In cases of older men or low-risk patients, regular medical tests are conducted to make sure the cancer isnt spreading. No other action is taken because the cancer is stable or growing so slowly it wont cause problems right away. If tests show the cancer is spreading, treatments can begin. Of those men assigned to active surveillance, about one-third will eventually need to have surgery or radiation.
The second approach to treating localized prostate cancer has been the use of radiation or surgery. This is effective for removing any tumors present but is typically associated with side effects in the urinary, sexual, and bowel function. Two common side effects include loss of control over urinary functions and erectile dysfunction
Who Are Good Candidates For Focal Therapy
When focal therapy for prostate cancer first began to be used in about 2007, it was only as an alternative to active surveillance in very low-risk patients. Since then, the use of focal therapy has expanded to include those with favorable intermediate risk disease . The best candidates have a prostate gland of about 40cc in size or a tumor in the lower half of a larger gland, a single visible tumor on MRI, and the absence of cancer elsewhere in the gland .
In each case, the doctor will consider the patients general health and mental outlook, the size and location of the tumors present, and their chances of spreading more. Use of tests such as MRI, ultrasound, and biopsy can help decide if a patient will benefit more from focal therapy or from traditional treatments.
Different Types Of Focal Therapy
- HIFU : HIFU focuses the energy of sound waves to create heat and destroy cancer cells. Just like a magnifying glass concentrating sun rays to burn a hole in the paper. During the procedure, an ultrasound probe is inserted into the patients rectum while the patient is asleep from anesthesia. Guided by MRI and ultrasound 3D-images, the physician finds the tumor, plus the area to be treated, and delivers the energy aimed at the diseased tissue in the prostate gland. HIFU is a noninvasive precision treatment that spares healthy tissue and lowers the chances of negative side effects associated with radical prostate surgery or radiation, such as impotence, incontinence and bowel function disturbance. UChicago Medicine is the first medical center in the Midwest to offer and perform this procedure with the newest Focal One advanced robotic HIFU technology. This fills a significant treatment void for men with localized prostate cancer who find themselves in between active surveillance and whole gland treatments such as radiation or surgery. The treatment has been used for years in both Europe and Asia.
Urologists Ariel Shalhav, MD, and Scott Eggener, MD, answer questions about new treatment options for prostate cancer, including focal therapy and HIFU, as well as specialized care programs for men diagnosed with advanced prostate cancer or at high risk for the disease.
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Focal Laser Ablation: The Casit Approach
Focal laser ablation achieves oncologic control by inducing hyperthermic conditions throughout the target lesion. Successful treatment requires accurate guidance of the laser fiber to the target lesion as well as real-time monitoring. Both of these tasks can be achieved with magnetic resonance imaging, however, this method is time consuming and expensive. We are developing an alternative approach in which ultrasound and interstitial probes are used for laser fiber guidance and treatment monitoring respectively .
This project is a multi-disciplinary effort involving urologists, radiologists, pathologists, engineers and industry collaborators. The video below outlines our journey which started with the development of targeted biopsy for prostate cancer diagnosis.
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All study patients were treated between 2013 and 2017, with a median patient age of 64 years.
Pre-treatment biopsy Gleason scores were 3 + 3 = 6 in 30.8% of patients 3 + 4 = 7 in 46.7% of patients and 4 + 3 = 7 in 22.5% of patients.
Most of the men had a pre-treatment clinical stage of cT1c. Nearly all of them had either one or two tumor sites on their gland.
This is an admirable mix of patients, suggested Eggener. “I give Dr Walser credit that two thirds of the patients he has treated have Gleason score seven or higher cancers, because most clinicians would agree that it should not be used routinely on people with lower grade cancers,” he said
The median PSA level of patients prior to treatment was 6.05 ng/mL and decreased to 3.25 ng/mL at 12 months post-treatment .
Tumor diameter above the median was the lone statistically significant predictor for a post-treatment positive MRI and thus the need for biopsy and the possibility of a confirmed recurrence.
Walser said that the patients in this study were overall highly educated and affluent. They tended to be white-collar professionals such as engineers and doctors who search online for alternative treatments to prostatectomy. Other alternative treatments including high intensity ultrasound and microwave ablation also appeal to this type of patient, he said.
Currently, FLA is not reimbursed by insurance or Medicare. Walser’s patients come via his Internet marketing or are self-referred.
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Featured Patient Testimonial: Dr David Mantik
As a physician speaking to a patient, I have on a number of occasions disclosed to them that I myself had prostate cancer and actually had this procedure and I highly recommend it for the appropriate candidates.
Dr. David Mantik is a radiation oncologist. For more than 40 years, hes specialized in the use of radiation therapy to treat patients with prostate cancer.
However, at the age of 79 when he noticed his PSA score was rising, Dr. Mantik went to see Dr. John Feller. Now in remission, Dr. Mantik shared why he chose laser focal therapy over radiation treatment for his prostate cancer.
Featured Patient Testimonial: Toms Story
I just felt like the technology and the skill level of HALO Dx was light years ahead of what was here available to me locally and thats why I made the choice to go down there. It just seems like a rational, logical alternative that you dont have to be a doctor to be able to appreciate.
Mri For Recurrent Prostate Cancer
With the limitations of US and CT imaging, MRI has been shown to be quite useful in the detection and staging of recurrent prostate tumors.959697MRI provides superior soft-tissue contrast resolution, high spatial resolution, multiplanar imaging capabilities, and a large FOV. The use of integrated endorectal and pelvic phased-array coils or the state-of-the-art multichannel phased array coil has led to improved visualization of the prostatic fossa. Although PI-RADS version 2.1 interpretation and reporting methods do not apply to posttreatment prostate cancer imaging, the technical standards of a high-quality mpMRI of the prostate in pretreatment setting governed by PI-RADS can be employed for posttreatment evaluation. The characteristic mpMRI findings of locally recurrent tumor include a hyperenhancing soft-tissue nodule in the prostatectomy fossa, which also exhibits isointensity to muscle on T1WI, mild hyperintensity on T2WI, and restricted diffusion. The use of mpMRI for recurrent prostate cancer continues to evolve and has potential to evaluate both local recurrence and distant bony and nodal metastases.98Functional information from MR spectroscopic imaging and DWI may complement morphologic MRI by reflecting tissue biochemistry and Brownian motion of water molecules, respectively. These functional imaging techniques may be used to supplement conventional MR imaging in diagnostic clinical studies.
The Mri Focal Laser Ablation Procedure
The following illustrations show the steps involved in MRI Focal Laser Ablation:
Advantages of MRI Focal Laser Ablation
- Outpatient procedure
- All future treatment options still open if necessary
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You will be contacted by the Scionti Prostate Center.
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Featured Patient Testimonial: Dr Terry Higgins
After receiving a prostate cancer diagnosis, Dr. Terry Higgins urologist warned him of the risk of side effects of standard-of-care prostate cancer treatments like a radical prostatectomy, which carries a 50% chance of causing erectile dysfunction, and a 25% chance of causing incontinence.
At just 53-years-old, those were odds that Dr. Higgins was not willing to accept. Dr. Higgins urologist then told him about laser focal therapy, a minimally invasive prostate cancer treatment pioneered by HALO Diagnostics.
Now a few years in remission, Dr. Higgins shared his story.
Pet Imaging For Recurrent Prostate Cancer
68Ga-PSMA is a promising new PET tracer targeting the extracellular domain of the PSMA protein.68Ga-PSMA has been shown with favorable sensitivity and specificity profiles compared with choline-based PET imaging techniques.103An early article demonstrated that PSMA-11 has a higher sensitivity for the detection of disease than F-18 choline in a head-to-head intrapatient comparison.104105A recent publication demonstrated that late 3-hour imaging of68Ga-PSMA helped clarify activity within the prostate due to decreased activity within the bladder at this time point.106In a retrospective study of 248 patients with BCR after RP, the detection rates of68Ga-PSMA PET/CT were 96.8, 93.0, 72.7, and 57.9% for PSA levels of 2, 1 to < 2, 0.5 to < 1, and 0.2 to < 0.5 ng/mL, respectively.107An article coming out of an institution using large amounts for11C-choline for recurrent prostate cancer detection demonstrated similar sensitivity of PSMA-11 to11C-choline, but they were also using higher11C-choline doses than other centers.108To the best of our knowledge, there has been no prospective multicenter trial to compare the clinical utility of11C-choline,18F-fluciclovine, and68Ga-PSMA PET tracers in recurrent prostate cancer.
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Other Factors Affecting Prostate Cancer Treatment Cost
Apart from the type of surgery or treatment and the choice of technology, the following are some of the factors that affect the overall prostate cancer treatment cost:
Type of Hospital
There are several hospitals around the world that provide world-class medical treatment to patients. The greater the number and quality of services offered by the hospital, the expensive is the treatment at the hospital.
Therefore, the total cost of prostate cancer treatment that you have to pay actually depends on the level of services that you expect from the hospital. To be able to receive five-star services from the hospital, you must be willing to pay lavishly for it.
Experience of the Surgeon
Expertise and skills of the treating doctor matter a lot when it comes to successful treatment of any cancer type. It takes a lot of patience, courage, and knowledge to treat a cancer patient and this is the reason why the most experienced surgeons tend to charge a greater fee for their services.
However, that does not mean that all the experienced and qualified surgeons charge fees that an average patient cannot afford. There are many highly educated and skilled doctors for prostate cancer treatment that offer their services with an equal compassion at a reasonable rate. Therefore, one must try to find a credible doctor with required credential who charges a fee that a patient can afford.
Length of Stay at the Hospital
Cost of Accommodation, Food, and Local Travel
|Cost per Day|
Compliance With Ethical Standards
The following authors declare no interest of interest: A van Luijtelaar, BM Greenwood, AB Barqawi, E Barret, JGR Bomers, MA Brausi, PL Choyke, MR Cooperberg, JF Feller, F Frauscher, SFM Jenniskens, L Klotz, G Kovacs, U Lindner, LS Marks, S May, TD Mcclure, R Montironi, SG Nour, TJ Polascik, AR Rastinehad, TM De Reyke, JS Reijnen, JJMCH de la Rosette, JPM Sedelaar, DS Sperling, JF Ward, A Villers, JJ FÃ¼tterer. HU Ahmed received a research trial funding from Sophiris Bio., Sonacare inc., BTG/Galil and Trod Medical and accomplished paid proctoring and lecturing for Sonacare Inc. and BTG/Galil and is medical consultant for Sophiris Bio. S Eggener is advisor/consultant for Insightec and Sophiris and investigator, advisor and consultant for Profound Medical. AK George received a research trial funding from Nanospectra Biosciences. S Ghai received a research trial funding from CLS and is also PI of a MRgFUS study. RG Hindley received a research trial funding and accomplished paid proctoring and lecturing for Sonacare Inc. S Loeb is consulting with GE global research and Lilly. DJ Margolis is ad-hoc consultant for Blue Earth Diagnostics. A Oto received a research grant from Profound Healthcare and is on the Medical Advisory Board of Profound Healthcare. EM Walser is consulting with CLS in Sweden.
The manuscript does not involve human participants and/or animals. Informed consent was waived, and no medical ethical approval was needed for this study.
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Our Workup Treatment And Follow
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What Is The Outlook For Patients Who Receive Focal Therapy
While the use of focal therapy for localized prostate cancer appears to be a promising development in a number of ways, it is still considered investigational and not yet part of standard therapy. There are a number of reasons for this, as follows:
- The criteria for selecting ideal candidates havent been fully agreed on. This is an important question because mistakenly using focal therapy in place of a more traditional treatment could allow a cancer to go under-treated.
- The criteria for defining an index lesion still need to be agreed on.
- The idea that the index lesion determines how the cancer will develop hasnt yet been proven.
- The factors that define treatment success or failure, and the triggers for re-treatment still need to be determined.
- The long-term effectiveness of focal therapy is unknown.
- It isnt clear that all side effects are eliminated by using focal therapy.
- Focal therapy doesnt allow for firsthand pathologic and biologic study of cancerous tissue, as can be done when using surgical treatment.
- Focal therapy sometimes leaves behind untreated cancer, which could possibly raise the risk of more serious problems in the future.
- The overall cost to the healthcare system may be greater for focal therapy than for standard treatments.
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