Cooking The Prostate Gland
26 Apr 2010
How many angels can dance on the head of a pin? No one knows. Nor has anyone, to this point, found the answer to treating prostate cancer. Now, a treatment called high-intensity focused ultrasound (HIFU) is available. So could this procedure be the ultimate way to cure prostate cancer?
In North America, every three minutes, a man is diagnosed with prostate cancer and every 15 minutes a man dies from it. The major problem has always been, which men should be treated, and when should doctors follow a wait-and-see policy?
Waiting to see what will happen has never been a logical move anytime cancer is diagnosed. The result is normally the spreading of the malignancy and eventually death. But prostate malignancy, unlike other cancers doesn’t always follow this rule.
For instance, some prostate cancers are "pussycats", only slightly cancerous, growing slowly and remaining localized for years. In fact, a 70 year old male with prostate cancer, may live for 15 years before the cancer becomes lethal, and by that time he may have died of something else. So why should doctors subject him to the devastating complications often associated with various forms of treatment?
The huge dilemma facing doctors and patients is that some prostate cancers are ravenous "tigers", growing rapidly and out to kill. Today, tests are available that help to separate tigers from pussycats, but they’re not 100 percent accurate. So, "when and when not" to treat is often a life or death decision that requires the wisdom of Solomon.
So today men who have prostate cancer face a number of confusing options. Radical prostatectomy, in which the entire prostate gland is surgically removed, has been considered the gold standard of treatment. But this is major surgery and there’s always the risk of urinary incontinence and impotence.
Urinary incontinence is encountered less frequently now than in the past as surgeons try to spare the nerves controlling urination during the operation. But it still occurs and many readers have told me they would never have consented to the surgery if the they had been fully informed they might end their final years in diapers.
Other therapies include external radiation therapy, insertion of radioactive seeds into the prostate gland, hormone treatment, chemotherapy and freezing the prostate gland. But none are without complications.So what is HIFU and how good is this therapy? HIFU uses energy to destroy tissue. I’m sure many of you remember using a magnifying glass to concentrate the sun’s rays on a piece of paper and see it catch on fire.
Today HIFU accomplishes the same thing, but uses complex computer-assisted equipment. Patients are given a spinal or general anesthesia. A rectal probe in then inserted which allows the doctor to outline the prostate gland. But the same probe also enables the surgeon to deliver intense thermal heat, up to 85degrees celsius (185 degrees fahrenheit), to destroy the gland and its malignancy. In effect, HIFU cooks malignant cells to death.
Following the surgery patients are often sent home the same day. A urinary catheter to drain the urine is needed for a few days. During that time destroyed prostate tissue is discharged through the catheter while healing takes place.
Patients who have an extremely enlarged prostate that has been causing obstruction of urinary flow, may require an operation to remove the blockage. But this surgery, if needed, can be done at the same time as the HIFU procedure.
HIFU is not for every patient. The malignancy must be confined to the prostate gland and tests such as the Gleason score, (A scale to judge the severity of the cancer), should be low.
Critics say that not enough time has elapsed to know whether there will be a low or high recurrence rate of cancer. There’s also insufficient data to know how many men will suffer from urinary incontinence and impotence.
Currently HIFU is available in some major Canadian cities, but is not covered by provincial medical insurance plans. The FDA (Food and Drug Administration) in the U.S has not approved HIFU until more long-term data is available. But for those who an afford it, being able to pay $20,000 and go home the same day is an appealing prospect.
