New prostate cancer therapy offers fewer side effects, more hope

One in eight men will develop prostate cancer in their lifetime. The good news is the vast majority of prostate cancer cases aren’t deadly.

But even so, prostate cancer comes with uncomfortable symptoms like pelvic pain, trouble urinating and bone pain.

There are two ways prostate cancer is typically treated:

• Prostatectomy, the surgical removal of the prostate, or a radical prostatectomy, which removes the prostate as well as the seminal vesicles and possibly nearby lymph nodes.
• Radiation therapy uses high-energy rays similar to X-rays to kill the cancer. It’s either done externally, where a machine outside the body directs radiation at the cancer cells, or internally, where radioactive seeds or pellets are surgically placed into or near the cancer to destroy its cells.

Not only are these two therapies pretty invasive, they can come with devastating side effects, including urinary incontinence and erectile dysfunction.

Luckily, other, less invasive treatments for prostate cancer are still under investigation — and one in particular is very promising…

Ultrasound method shows success

MRI-guided transurethral ultrasound ablation (TULSA) is a minimally invasive procedure that uses a small catheter-like device to precisely apply ultrasound and MRI-guided thermotherapy (producing high heat) to destroy cancerous tissue within the prostate gland. TULSA can be performed in two to three hours in an outpatient or inpatient setting under general or spinal anesthesia.

According to Dr. Steven S. Raman, M.D., FASR, FSIR, professor of radiology, urology and surgery at the David Geffen School of Medicine at UCLA, “This image-guided therapy maximizes our ability to kill cancer cells while minimizing collateral damage to the prostate to achieve the ultimate trifecta in prostate cancer treatment: full local cancer control while maintaining urinary continence and potency. The latter are the complications of most prostate cancer therapies that patients hate and often result from a lack of precision in treatment monitoring.”

As lead author of a prospective observational study that put TULSA to the test, he has the results to back up his statement…

• Participants in that study showed improvement in the reduction of cancer, prostate size and prostate-specific antigen (PSA) levels, a marker for cancer.
• At one year after TULSA, cancer was undetectable on follow-up biopsy by 76 percent, and there was a decrease in median prostate volume by 92 percent.
• At five years after TULSA, there was a decrease in PSA from 6.3ng/ml to 0.63 ng/ml.

And, compared to alternative surgical, radiation and thermal therapy (US-guided HIFU or cryotherapy), TULSA had a very favorable side effect profile…

By 5 years following the procedure, 92 percent of patients recovered continence and 87 percent preserved erectile function.

However, TULSA does not preclude future treatment with surgery or radiation. Of the 115 men participating in the study, 25 received follow-up conventional treatment with surgery or radiation because of residual or new tumors.

Dr. Ramen believes the success of TULSA represents a revolution in whole-gland treatment for prostate cancer and plans to study the procedure’s effectiveness in the CAPTAIN trial, a randomized control trial comparing TULSA with radical prostatectomy.

 “We have more research to do, but if validated, TULSA has the potential to change the standard of care for thousands of men.”

Monitoring prostate cancer risk

As PSA testing for prostate cancer has fallen out of favor over the past decade, the number of metastatic prostate cancer cases has risen. Between 2003 and 2017, patients diagnosed with prostate cancer that has spread to other parts of the body increased from 4 percent to 8 percent.

The 5-year survival rate for metastatic prostate cancer is a dismal 31 percent, compared with the nearly 100 percent 5-year survival rate for prostate cancer caught in the early stages. That’s why it’s so important to know the following risk factors so that you can discuss with your doctor whether and how often you should be tested for prostate cancer:

• Age. More than 6 in 10 cases of prostate cancer occur in men who are 65 and up.
• Family history. If your father, brother or other close blood relative had prostate cancer, it raises your risk of the disease, especially if they were diagnosed before age 60.
• Race. If you are African American, you’re more likely to develop prostate cancer, and it’s more likely to be advanced when it’s diagnosed. Don’t wait to see a doctor.
• Lifestyle. Maintaining a healthy weight and eating a diet high in specific micronutrients are two ways you can help lower your risk of the disease. Multiple studies also show exercise can shrink prostate tumors and extend survival and quality of life.

Sources:

New treatment option for prostate cancer shows successful outcomes — EurekAlert!

How Is Prostate Cancer Treated? — Centers for Disease Control and Prevention