Other forms of treatment for early stage (localized) prostate cancer

The two other important forms of treatment currently available as therapies for early stage prostate cancer are cryotherapy and high-intensity focused ultrasound.

Cryotherapy

Cryotherapy (also known as cryosurgery or cryoablation) is an old technique which was reborn as a result of advances in technical capability. Rather than removing the prostate (as in conventional surgery) or using radiation therapy, cryotherapy is a method of freezing the prostate and other appropriate nearby tissues to extremely low temperatures. This was done historically using liquid nitrogen and liquid argon, but is now carried out using argon gas technology. This technique is designed to kill all the prostate cancer tissue without having to take the risks involved in carrying out invasive surgery.

Cryotherapy is an interesting and important addition to the options which physicians can offer patients with prostate cancer. Until comparatively recently many still considered it to be an investigational technique, but in 2008 the American Urological Association first issued guidelines for the use of cryotherapy as a treatment for low risk, localized prostate cancer. However, even some physicians who have carried out several hundred cryosurgical procedures for prostate cancer will still say that they are unsure of the precise future role for this form of therapy.

If you decide that cryotherapy is an option which you wish to consider, you should certainly seek out a physician who has considerable experience with this technique. You should ask that physician very specific questions about whether cryosurgery is appropriate for you. Most importantly, you should ask whether that physician believes that cryosurgery can be used to cure your cancer or whether it would be given primarily to reduce the amount of cancer in your body.

One of the potential benefits of crotherapy is that it may prove to be usable on a regular basis for the focal therapy of carefully selected patients with prostate cancer limited to one area of the prostate. However, focal therapy really is still under investigation at this time, and few physicians have significant experience in the appropriate use of this technique.

The known side effects of cryotherapy can include impotence (in about 80 percent of patients), scarring of the urethra and urinary dysfunction (which are relatively unusual), and irritation of the bladder, the urethra, the rectal wall, and the genitalia. This last group of side effects can include pain on urination, a burning sensation during urination, frequent and unexpected urination, blood in the urine (hematuria), and swelling of the penis or the scrotum.

High-Intensity Focused Ultrasound (HIFU)

HIFU is a newer therapeutic option than cryotherapy. It has not yet been approved as a treatment regimen for prostate cancer in the USA, but it has been approved in Europe and is available in other countries too (including Canada, Mexico and the Dominican Republic). A detailed report on the clinical use of HIFU to date is available on another page.

The basic principle behind HIFU is that by focusing a beam of ultrasound waves through the wall of the rectum into the prostate, one can heat the prostate tissues to such high levels that they are effectively “cooked.” This kills the prostate tissues and (in theory) the prostate cancer too. According to one physician who has been carrying out HIFU for several years now, “The control and precision of HIFU allow the accomplished surgeon to accurately target the tissue to be destroyed without injuring adjacent tissue. HIFU destroys tissue by heat, rather than by cavitation or mechanical shearing forces.”

There are basically two types of HIFU equipment available (in various countries), and  “second generation” equipment started to become available in the past few years. The operating principles behind each set of equipment are slightly different, and therefore the results obtained by one group of physicians using one type of equipment are not necessarily comparable to the results obtained by a different set of physicians using different equipment (or even the same group of physicians using the two different types of equipment)!

Only very recently have the first relatively long-term results started to be published. These results are based on the use of “prototypes” and “first generation” equipment and are based on experience treating patients during the earliest stages of the use of this equipment (i.e., during the physicians’ “learning curve”). As a consequence, it is almost inevitable that the results to date are not as good as one might expect if one went today to an experienced HIFU specialist who had access to “second generation” equipment.

The bottom line is that there is still a great deal to be learned about the real potential of HIFU, and it will probably be another 10 years before we can make definitive decisions about the value of this technique in the management of localized prostate cancer compared to surgery and radiation.

What is absolutely certain is that if this is a treatment technique that you want to consider, you would be wise to go to a center that had already treated as many patients as possible and that had access to and at least some experience with using the latest equipment.

Like cryotherapy, HIFU also has the potential to be used in the focal therapy of carefully selected patients with prostate cancer limited to one area of the prostate. Again, however, focal therapy really is still under investigation at this time, and few physicians have significant experience in the appropriate use of this technique.

Known side effects of HIFU include the short-term retention of urine (because of sloughing of prostate tissue and tissue swelling), a risk for anal fistula and incontinence (both of which seem to be relatively small), and a significant risk for impotence.

A number of clinical trials of HIFU (using both types of available equipment) are now ongoing in the USA and in Canada. Eligible patients are usually those with localized, low-risk prostate cancer, which presents the interesting question of whether they should actually be treated at all or whether they are better managed with some form of expectant management (i.e., watchful waiting or active surveillance). However, that is a question which is probably unresolvable as yet.

Content on this page last reviewed and updated December 19, 2008.
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