At the Prostate Cancer Institute of Los Angeles we are committed to providing our patients with the best and most effective therapy possible. To learn more about procedures and prostate cancer treatment options offered at our state-of-the-art facility, please call our urological experts at (310) 341-2557.
Prostate Carcinoma Treatment Therapies
When a man has been diagnosed with prostate cancer, two treatment approaches are traditionally used:
Active surveillance is typically reserved for patients with small volumes of non-aggressive cancer or for patients who are not in good health. Patients undergoing active surveillance are not initially treated with any type of therapy. Rather, a man’s cancer is observed over time and only when the volume or aggressiveness of the cancer accelerates is treatment with curative intent (such as surgery or radiation therapy) offered. Active surveillance is offered with the aim of not needlessly over-treating men, thereby preserving their prostate and their quality of life. However, there are two major disadvantage of active surveillance including:
A. If the original cancer is not properly identified through appropriate imaging and correct biopsy techniques, an otherwise sizeable and aggressive (and therefore life-threatening) prostate carcinoma can be incorrectly diagnosed as small and non-aggressive. Therefore, the recommendation for active surveillance can be made in error, and a patient with life-threatening cancer can have a delay in the treatment of his cancer (by being simply observed and not being treated) and, an otherwise curable condition goes untreated. Such an untreated cancer now has time to spread outside of the prostate and spread through out a patient’s body, resulting in pain, morbidity, and ultimately death. In short, in some men the incorrect recommendation of active surveillance can lead to an otherwise curable prostate cancer symptoms not being treated in time, and therefore no longer being curable! The misdiagnosis and understaging of a cancer can be minimized with the use of Perfusion Dynamic MRIs and MR Fusion biopsies.
B. For patients in Los Angeles who are correctly identified as initially having small, non-aggressive cancers and are placed on active surveillance: such patients undergo a repeat prostate biopsies every one to two years and are treated (with surgery or radiation therapy) only when there has been progression of the cancer (that is only when the size of the cancer becomes larger or when the cancer becomes more aggressive). With this approach, during this observation period while waiting for the cancer to grow, a significant number of men can have so much progression of their cancer that they are no longer curable!
Whole gland therapies
For men in Los Angeles who decide to not undergo active surveillance and undergo treatment options with curative intent (with surgery or radiation therapy) their entire prostate is treated, even if they have disease limited to only one segment of their prostate. For example, if a man is noted to have cancer only in the right lobe of his prostate current standard techniques, whether they include surgery or radiation therapy or brachytherapy, both the right and left lobes will be treated. The reason for this has been that there has been no reliable way to identify the exact extent and location of the prostate carcinoma. In order to not undertreat a patient, most patients with focal disease are being over-treated, as their entire prostate gland will undergo radiation therapy or surgery.
Focal therapy provides an exciting new alternative for patients with focal disease (disease localized to only limited segments of their prostate). Given the advent of advanced prostate imaging (such as dynamic perfusion prostate MRI studies), new prostate biopsy techniques (patient friendly prostate biopsy) and cancer mapping techniques that are now available from the Prostate Cancer Institute of LA, we are now able to reliably identify the extent of disease in the prostate and determine the location of the prostate cancer in most men.
Being able to precisely identify and map a patient’s cancer allows doctors to identify which patients have focal disease. In turn, we can identify which patients are candidates for focal therapy, in which only the diseased segment of the prostate is treated and the entire gland no longer needs to be needlessly over treated. This approach is very similar to women being treated for breast cancer. Several decades ago when a woman was diagnosed with breast cancer she would undergo complete removal of her breast, which is akin to total removal of the prostate or performing radiation to the entire prostate. However, because of better localization techniques, most women in Beverly Hills who are diagnosed with breast cancer today only undergo treatment of the segment of their breast that is diseased with cancer and the rest of the breast, namely the remaining healthy breast tissue, is preserved. Likewise, for appropriate patients with prostate cancer symptoms, only the segment of the prostate which harbors the cancer needs to be treated, thereby allowing men to preserve the remaining healthy segments of their prostate.
Clearly, most men welcome not being over-treated and being able to preserve their healthy tissue. For this reason there has been a strong movement by men diagnosed with prostate cancer to identify if they are a candidate for focal therapy, and thereby optimizing their chances of being cured while preserving their normal tissue, minimize erectile dysfunction and control of urination. It’s important to note that patients who undergo whole gland therapy, whether with surgery or radiation, run the risk of developing erectile dysfunction (impotence), loss of urinary control and possibly change in the sensation of orgasm. The advent of focal therapy for patients with carcinoma provides the opportunity for men to preserve their healthy tissues and therefore minimize erectile dysfunction or losing control of the urinary function. By preserving their normal bodily functions, men are able to maintain their excellent quality of life.
The Prostate Cancer Institute of LA have dedicated our sole focus to providing state-of-the-art focal therapy care for patients. We have brought together a team of focal therapy experts including urologic surgeons with expertise in robotic prostatectomy surgery, radiation oncologists with expertise in the most advanced radiation therapy modalities (TrueBeam IMRT), experienced brachy-therapists, leading radiologists in the field of prostate imaging, pathologists with expertise in prostate preservation treatment, and oncologists. By having a team of leading focal therapy physicians, we have been able to create focal therapy programs to help patients in Beverly Hills with all stages of cancer be treated most with the most effective modalities.
While we are able to provide the most advanced robotic surgery, radiation therapy, and brachytherapy options for patients who need to undergo whole gland therapies, we are in particularly excited to be able to provide focal therapies for appropriate candidates with prostate carcinoma. The fact that many men can now preserve their healthy prostatic tissue, and therefore be able to preserve their normal body function and quality of life, has created a huge groundswell of interest across the country for men who have recently been diagnosed with prostate cancer. We are excited to be able to offer a new paradigm of focal therapy treatment for patients with cancer and will be happy to work with you to identify which modality will be the most effective approach for you.
Learn more about Focal Therapy by visiting Wikipedia.org.
There are currently three techniques available for patients undergoing focal therapy to preserve prostate tissue:
- MRI Fusion TrueBeam IMRT (external beam intensity modulated radiation therapy)
- MR Fusion Brachytherapy
- MRI fusion HIFU (high-intensity focused ultrasound ablation)
Contact Our Experts Today
To determine if you are a candidate for focal therapy for prostate cancer treatment, you can reach Dr. Kia Michel and his team of prostate preservation experts at the Prostate Cancer Institute of Los Angeles by contacting us today.
Next, read about MRI Truebeam.