HIFU México :: Prostate Cancer treatment

Treatments

Prostate Cancer Treatments
There are numerous treatments for Prostate cancer and each has its own benefits and drawbacks. Patients and their physicians must weigh many factors when determining the best treatment option. Age, Gleason score (measures aggressiveness), PSA, lifestyle and quality of life issues all play a very important part in the equation of finding the optimal treatment.

Treatments available are:
High Intensity Focused Ultrasound (HIFU)
Radical prostatectomy
Radiation therapy
Hormone therapy
Cryotherapy

Click here for a Treatment Comparison chart

Some patients are choosing no treatment at all, or watchful waiting, in which the doctor closely monitors the patient’s condition. There is no treatment involved until symptoms either appear or change.

Watchful waiting is usually the “treatment” used in older men with an early stage of the disease and who suffer from other medical problems.

The treatment modalities are described below in more detail.

High Intensity Focused Ultrasound (HIFU)
HIFU with the Sonablate® 500 is a non invasive treatment option for prostate cancer that uses a transrectal probe to focus ultrasound waves in the prostate. In the focal zone, the temperature is rapidly elevated which causes tissue destruction. During HIFU, the entire prostate is treated or ablated. The entire gland is ablated to make sure there is less chance for cancer to recur in tissue that might have been left in the area. HIFU with the Sonablate® 500 takes between one to three hours and is performed as an out-patient procedure under a spinal (epidural) anesthesia. Recovery is minimal. There is a catheter that is inserted during the procedure that is usually worn for one to three weeks as the body heals so the bladder can empty properly. People usually are up and walking around within hours after HIFU and can return to a normal lifestyle within a couple of days. HIFU with the Sonablate® 500 has very low rates of both impotence and incontinence. Click here to compare HIFU to other treatment modalities. Learn more about HIFU

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Radical Prostatectomy
A radical prostatectomy is surgery to remove the entire prostate gland and some of the tissue around it and may be done by open or laparoscopic surgery. An open prostatectomy usually takes two to four hours and a laparoscopic prostatectomy can take up to eight hours. The procedure is usually preformed under general anesthesia, requires a three to seven day hospital stay and a catheter is worn after the procedure for up to three weeks. Full recovery and mobility can take up to eight weeks. Following a radical prostatectomy, impotence rates are as high as 70% - 80% and incontinence rates between 50% - 80%. (The rate of bleeding during this procedure is variable but generally high, needing in almost all cases blood transfusion)

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Radiation Therapy
There are two primary types of radiation therapy: External Beam Radiation Therapy (“EBRT”) and brachytherapy or seed implants. EBRT is usually recommended for men with a prostate volume less than 60 grams and involves four to six weeks of radiation directed at the cancer from outside of the body. Brachytherapy is radiation therapy transmitted by tiny radioactive pellets placed inside the prostate.

Radiation therapy has improved greatly in recent years; however, often the area of radiation is not precisely controlled and the radioactivity can extend beyond the therapeutic field and affect the neuro-vascular bundles and urinary sphincter causing permanent damage that leads to impotence and incontinence. About a quarter to a third of men who receive radiation notice a change in their ability to have erections. This change most often develops slowly over the first year or so after radiotherapy. Approximately 20% of radiation patients suffer from incontinence.

There is also a chance for damage to the rectum and the bowels as a result of ionizing radiation including proctitis or a rectal fistula (a hole that connects the rectum with other organs, mainly the bladder) which in severe cases may require a colonoscopy. Recent studies also show that radiation for prostate cancer causes a greater risk for developing rectal or colon cancer. The radiation field may also extend to the bladder causing radiation cystitis, an irritation of the bladder not caused by a urinary tract infection and in severe cases, as late complication shrinkage of the bladder secondary to the scarring muscle.

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Hormone Therapy
Hormone therapy, which reduces the amount of testosterone in the bloodstream and thereby deprives a prostate tumor of a necessary stimulus, has been shown in clinical trials to extend life and delay time to disease progression. Nearly all prostate cancers treated with hormone therapy become resistant to this treatment over a period of months or years. Possible side effects of hormone therapy include: hot flashes, breast tenderness and growth of breast tissue, osteoporosis, anemia, decreased mental acuity, loss of muscle mass, weight gain, fatigue, decrease in HDL ("good") cholesterol and depression.

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Cryotherapy
Cryotherapy, also known as cryosurgery or cryoablation, is a minimally invasive procedure that involves freezing the cells in the prostate to bring about destruction or elimination. Cryotherapy begins with an infusion of toxic argon gas that results in cellular destruction of the prostate. The infusion of argon gas is immediately followed by an infusion of helium to essentially thaw the tissue. This cycle is repeated twice to achieve cancer cell destruction. Although it is considered a minimally invasive procedure, it is still a major operation and requires an overnight hospital stay. A catheter is inserted after the procedure and worn for two to three weeks. Over 90% of the patients treated with cryotherapy are impotent and 10% - 30% are incontinent.

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Treatment Comparison Chart
(Click here for printable version)

Treatment	Description	Selected Risks*	Recovery	Selected Outcomes
High Intensity Focused Ultrasound (HIFU) as approved and used outside the U.S.	Minimally invasive use of intersecting, precision-focused ultrasound waves to ablate diseased tissue	In approved countries Incontinence – 0.6%¹ Impotence – 20%¹	Temporary catheter worn for approximately 2-3 weeks; resume normal lifestyle almost immediately	94%* biochemical disease-free survival rate at 3 years^{1 *pretreatment PSA less than 10ng/mL}
Cryotherapy	Minimally invasive freezing of cancerous cells	Incontinence – 7.5%² Impotence – 93%² Urinary obstruction less likely than with radical prostatectomy	Resume a normal lifestyle after 2 to 3 days of minor discomfort	82% negative biopsy at 2 years² 87% negative biopsy rate at 5 years⁴
Radical Prostatectomy	Major surgery to remove prostate	Incontinence – 39-49%³ Impotence – 80-91%³ Urinary obstruction is common	3 days in hospital followed by 3 to 5 weeks to recover	74% recurrence-free survival rate, 10 years⁵
External Beam Radiation	6 to 8 week treatment, beaming radiation through healthy tissues	Incontinence – 6-7%³ Impotence – 41-55%³ Urinary obstruction is less common than with cryotherapy or radical prostatectomy Occasional abnormal bowel functions	Five treatments per week for 6 to 8 weeks, up to 2 months fatigue after full course of treatment	33% negative biopsy, 6.8 years⁶ 73% negative biopsy at 24 months⁷
Internal Radiation Seeds (Brachytherapy)	Permanent implantation of 80 to 100 radioactive pellets in prostate	Diarrhea or constipation, tenesmus and rectal pressure Impotence – 15% - 20%⁹ Morbidities affect the urinary, lower gastrointestinal and sexual functions⁹	Up to 1 week of residual pain and rectal problems	74% negative biopsy, 18 months⁹

Read personal testimonials from men who chose HIFU

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