Use Of Androgen Deprivation Therapy For Treatment Of Prostate Cancer Associated With Increased Risk Of Acute Kidney Injury
In a study that included more than 10,000 men with nonmetastatic prostate cancer, use of androgen deprivation therapy was associated with a significantly increased risk of acute kidney injury, with variations observed with certain types of androgen deprivation therapies, according to a study in the …
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.
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.
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About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
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What Treatments Are Used In Focal Therapy For Localized Prostate Cancer
Focal therapy uses ablation, which is the use of extreme temperatures to destroy tissue. In focal ablation, the area of the prostate that contains the index lesion is targeted, rather than treating the entire prostate gland. Focal ablation techniques include:
- Cryotherapy: The use of very cold gases passed through needles to freeze and destroy cancer tissue.
- HIFU : The use of high-frequency sound waves directed at the tumor through an ultrasound probe inserted into the rectum. The high intensity waves cause the diseased tissue to heat up and die.
- : A drug called a photosensitizer is injected into the bloodstream. This drug then absorbs light rays directed at the tumor, and produces an active form of oxygen that destroys cancer cells.
- Laser ablation: The use of laser radiation energy pinpointed to a very small area to burn away cancerous tissue. Some laser ablation has the advantage of being able to be performed at the same time as magnetic resonance imaging , allowing very specific targeting and also real-time views of results.
Recommended Reading: How Long Prostate Cancer Spread
What Is The Prognosis For People Who Have Prostate Cancer
Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.
Mayo Clinic Q And A: Advances In Ablation For Prostate Cancer
DEAR MAYO CLINIC: My husband was diagnosed with prostate cancer, and we are looking at treatment options. One doctor suggested a prostatectomy, but my husband finds ablation appealing because of quality of life advantages. I’ve been reading about ablations and came across information about different techniques. I am wondering if one technique or process is better, or if surgery is more successful?
ANSWER: I’m sorry to hear that your husband is dealing with prostate cancer, which is the most common cancer in American men. Approximately 192,000 men will be diagnosed with prostate cancer in 2020, according to the American Cancer Society.
Prostate cancer is more likely to develop in older men, typically those over 60, and it is more common in African American men. Given advances in care, most men will not die from prostate cancer.
There are many options for treating prostate cancer, depending on the grade and stage of the cancer. In recent years, the guidelines for treating prostate cancer have changed. Also, technological advances in imaging and treatment have made it possible for some men to avoid radical surgery that may come with adverse side effects. In recent years, surgeons are finding that ablation is a viable alternative to traditional surgery.
The ability to control the application of the heat or cold, and get the energy to stay within an intended boundary and not spread even 1 or 2 millimeters beyond, has proven difficult.
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What Questions Should I Ask My Healthcare Provider
If you have prostate cancer, you may want to ask your healthcare provider:
- Why did I get prostate cancer?
- What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
- Has the cancer spread outside of the prostate gland?
- What is the best treatment for the stage of prostate cancer I have?
- If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
- What are the treatment risks and side effects?
- Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
- Am I at risk for other types of cancer?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.
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
Also Check: Prostate Cancer Incidence By Country
Dear Mayo Clinic: Advances In Ablation For Prostate Cancer
DEAR MAYO CLINIC: My husband was diagnosed with prostate cancer, and we are looking at treatment options. One doctor suggested a prostatectomy, but my husband finds ablation appealing because of quality of life advantages. I’ve been reading about ablations and came across information about different techniques. I am wondering if one technique or process is better, or if surgery is more successful?
ANSWER: I’m sorry to hear that your husband is dealing with prostate cancer, which is the most common cancer in American men. Approximately 192,000 men will be diagnosed with prostate cancer in 2020, according to the American Cancer Society.
Prostate cancer is more likely to develop in older men, typically those over 60, and it is more common in African American men. Given advances in care, most men will not die from prostate cancer.
There are many options for treating prostate cancer, depending on the grade and stage of the cancer. In recent years, the guidelines for treating prostate cancer have changed. Also, technological advances in imaging and treatment have made it possible for some men to avoid radical surgery that may come with adverse side effects. In recent years, surgeons are finding that ablation is a viable alternative to traditional surgery.
The ability to control the application of the heat or cold, and get the energy to stay within an intended boundary and not spread even 1 or 2 millimeters beyond, has proven difficult.
More Treatment Stories In Our Patients Own Words
Dr. David: A Whole New Chapter of Good Health
My journey began in September of 2020 with an elevated PSA and as any man can attest its a silent fear we all hope not to encounter. After researching the many options of treatments, I found your website that gave me hope of the best treatment possible. From my very first telephone call to the follow up MRI in September 2021, I could never have asked for a more thorough, professional, articulate, personal and pleasant experience. You provided explicit and detailed explanations of all my assessments, test results and recommended procedures while providing the most valuable tool of all you listened to my questions and concerns. Your responses put me at ease that I had made the right choice in finding you for treatment of my prostate cancer.
My hope is that you truly sense that my two small words of saying thank you do not even begin to hold their meaning. My health is excellent, the fearful diagnosis of prostate cancer is behind me with you providing the best treatment any man could possibly hope for and as I continue to follow your regime of follow up exams, I feel its a whole new chapter of good health to enjoy!
Steves Story
Kevin: An Informed Decision
Warren: A Life-Changing Experience
Hermans story
Also Check: How Long Does It Take For Prostate Cancer To Spread
Great News For Prostate Cancer Patients
Whats the great news? Patient-reported sexual function and urinary continence after MRgFUS focal therapy is superior, compared with data from both radical prostatectomy and whole-gland beam radiation. The two-year cancer control rate is comparable. In short, MRgFUS offers intermediate risk patients a way to avoid or defer whole-gland treatment while preserving urinary and sexual function.
At the Sperling Prostate Center, we are honored and grateful to have participated in this study. Our experience and state-of-the-art MRgFUS system place us on a par with large, authoritative institutions, something we are justly proud of. Most importantly, were all in this together as we research and test advantageous, effective treatments. Our shared goal is the preservation of mens lives along with the highest possible quality of life as we seek to vanquish prostate cancer once and for all.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
Q& a: Advances In Ablation For Prostate Cancer
DEAR MAYO CLINIC: My husband was diagnosed with prostate cancer, and we are looking at treatment options. One doctor suggested a prostatectomy, but my husband finds ablation appealing because of quality of life advantages. I’ve been reading about ablations and came across information about different techniques. I am wondering if one technique or process is better, or if surgery is more successful?
I’m sorry to hear that your husband is dealing with prostate cancer, which is the most common cancer in American men. Approximately 192,000 men will be diagnosed with prostate cancer in 2020, according to the American Cancer Society.
Prostate cancer is more likely to develop in older men, typically those over 60, and it is more common in African American men. Given advances in care, most men will not die from prostate cancer.
There are many options for treating prostate cancer, depending on the grade and stage of the cancer. In recent years, the guidelines for treating prostate cancer have changed. Also, technological advances in imaging and treatment have made it possible for some men to avoid radical surgery that may come with adverse side effects. In recent years, surgeons are finding that ablation is a viable alternative to traditional surgery.
The ability to control the application of the heat or cold, and get the energy to stay within an intended boundary and not spread even 1 or 2 millimeters beyond, has proven difficult.
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Laser Ablation Becomes Increasingly Viable Treatment For Prostate Cancer
Prostate cancer patients may soon have a new option to treat their disease: laser heat. UCLA researchers have found that focal laser ablation the precise application of heat via laser to a tumor is both feasible and safe in men with intermediate risk prostate cancer.
The Phase 1 study, published June 10 in the peer-reviewed Journal of Urology, found no serious adverse effects or changes in urinary or sexual function six months after the procedure. The technique uses magnetic resonance imaging, or MRI, to guide the insertion of a laser fiber into cancerous tumors. When heated, the laser destroys the cancerous tissue.
A follow-up study, presented in a poster presentation at the American Urology Association meeting in May, showed the potential to transfer this treatment for the first time into a clinic setting, using a special device that combines both MRI and ultrasound for real-time imaging. The Artemis device arrived at UCLA in 2009. Since then, 2000 image-fusion biopsies have been performed the most in the U.S. – and this large experience has paved the way for treatment to be done in the same way.
Up until now, capturing an image of a prostate cancer has been difficult because prostate tissue and tumor tissue are so similar. Precise, non-invasive surgical treatment has proved difficult as a result.
The laser treatment is not yet approved for use in prostate cancer by the U.S. Food and Drug Administration.
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What Causes Prostate Cancer
Experts arent sure why some cells in the prostate gland become cancerous . Genetics appear to play a role. For example:
- Youre two to three times more likely to get prostate cancer if your father, brother or son has the disease.
- Inherited mutated breast cancer genes and other gene mutations contribute to a small number of prostate cancers.
Read Also: What Type Of Anemia Is Associated With Prostate Cancer
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What Is A Biopsy And How Effective Is It
A needle biopsy is the only way to diagnose prostate cancer when it is suspected. But there are problems with the method most commonly used, called transrectal ultrasound guided biopsy. These problems often lead to inaccurate diagnosis.
For the last two decades, TRUS biopsy has been used to diagnose prostate malignancy. It is actually a blind and random procedure. Specific prostate tumors, especially very small ones, cannot be identified because ultrasound cannot visually detect specific cancer sites. Therefore, it is blind to tumors. In addition, TRUS biopsies tend to target the peripheral aspects of the gland and are likely to miss 30-40% of prostate cancer located in the anterior, midline transition zone, or apex. This is called sampling error. To attempt to overcome it, TRUS biopsies typically average 12-14 needles saturation biopsies use as many as 24 needles. The more needles used, the greater the risk of discomfort, infection, and urinary or sexual side effects while tumors continued to be missed. No other type of tumor cancer is biopsied this way!
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‘routine’ Use Of Focal Therapy For Prostate Cancer In Next 5 Years
Nick Mulcahy
There will be “routine application” and “broader acceptance” of minimally invasive focal therapies for early-stage prostate cancer within the next 5 years in the United States, predict a trio of clinicians in a new essay July 28 in JAMA Surgery.
They maintain that focal therapy offers a “middle ground” between two extremes: treating the whole gland with radical prostatectomy or radiotherapy, and not treating immediately via active surveillance or watchful waiting.
Focal therapy typically treats the primary lesion within the prostate, while leaving the rest of the gland intact. Most often performed with cryoablation or high-intensity focused ultrasound , it can also be carried out with a variety of technologies, including transurethral ultrasound ablation and focal laser ablation.
The shift to focal therapy will coincide with maturing, long-term data from studies with various technologies, predict the authors, led by Amir Lebastchi, MD, a urologist at the University of Southern California.
“Standard adoption of focal therapy is ultimately dependent on the availability of robust level I evidence, which in turn will drive medical societies and payees,” the authors also write.
But payees are already making changes, even without such data, they add.
I do expect its use will in fact increase in the next 5 years.
The challenge with focal therapy regardless of energy modality remains patient selection and accurate ablation zone definition, he added.