Men with small volumes of non-aggressive prostate cancer can delay their therapy until their prostate cancer becomes larger or more aggressive, at which time men will undergo treatment of their prostate cancer. This is called active surveillance.
While active surveillance can be effective for some men, there is always the risk that the initial volume or aggressiveness of the disease may have been underestimated and that by delaying treatment, a patient’s outcomes may have been compromised.
Patients who are appropriately placed on active surveillance, are monitored over time with repeat clinical exams (PSA testing and digital rectal exams), and repeat needle biopsies. On follow-up biopsies, patients typically move forward with treatment with curative intent (for example surgery or radiation therapy) when their prostate cancer has progressed or when they no longer want to be on active surveillance.
Traditionally in both of these situations, patients will undergo treatment of the entire prostate gland with either full removal of their prostate surgically or with radiation applied to their entire prostate gland. As noted, both of these therapies have the potential of sexual and/or urinary side-effects. So in effect, men on active surveillance, delay their prostate cancer therapy until cancer grows to a larger size or when cancer becomes more aggressive. In both of these situations, the outcomes of their treatment can be compromised.
However, HIFU, coupled with MRI imaging and more recent mapping techniques, offers a new treatment paradigm: focal prostate cancer therapy.
What is Focal Prostate Therapy?
Focal therapy is appropriate for patients with cancers involving less than half the volume of their prostate. In such cases, the entire gland does not need to be treated. Only the diseased areas are treated while sparing the normal healthy tissue. HIFU allows a physician to specifically target a desired area of the prostate with great precision, thereby allowing effective focal therapy to be performed. The involved area of the prostate is identified and mapped based on MRI and biopsy results. This information is used real time, to map out the area that needs to be treated while preserving the normal tissue. HIFU is then delivered specifically to the targeted area, thereby destroying the cancerous cells, while preserving the normal cells outside of the treatment areas.
By being able to preserve the normal, healthy structures within and around the prostate, HIFU focal therapy is able to preserve a man’s normal urinary and sexual function, while effectively treating his prostate cancer. HIFU is performed as an outpatient. No incisions are necessary. The procedure is typically performed over a three hour period at our Los Angeles office. Patients go home a few hours after completion of the HIFU therapy and have just about no down time.
Results after HIFU focal therapy have shown to be excellent. HIFU focal therapy for prostate cancer can effectively eradicate cancer while preserving sexual and urinary functions in a male.
Which is the Right Choice?
So, with active surveillance men wait and let their cancers grow, until which time they have a more advanced volume or aggressiveness of the disease and at that time they receive prostate cancer treatments. Whereas, with HIFU focal therapy, men don’t delay their treatment. Men with small volumes of disease treat their cancers with HIFU before cancer has a chance to grow to a larger volume or become more aggressive.
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