Focal therapy offers middle ground for some prostate cancer patients
Men with low-risk prostate cancer who previously had to choose between aggressive treatment, with the potential for significant side effects, and active surveillance, with the risk of disease progression, may have a new option. Focal laser ablation uses precisely targeted heat, delivered through a small insertion and guided into the prostate by magnetic resonance imaging, to burn away cancerous cells in the prostate.
A small, phase 1 trial, to published early online in the journal Radiology, found that this approach, designed to treat just the diseased portion of the prostate rather than removing or irradiating the entire gland, is safe and can be performed without the troubling complications associated with more aggressive therapies.
None of the nine men treated in the study had a significant side effect. Six months after therapy, seven of the nine patients (78%) no longer had evidence of cancerous tissue in biopsies of the treated area.
"Focal therapy is the male version of a lumpectomy for breast cancer," said study author Scott Eggener, MD, associate professor of surgery at the University of Chicago Medicine. "Rather than removing the entire organ, we are testing this less-invasive way of destroying just the cancer and leaving healthy tissue in place."
"This experimental approach appears to combine the most attractive element of treatment, eradication of the cancer, with the most appealing element of active surveillance, maintaining quality of life," said Aytekin Oto, MD, professor of radiology and chief of abdominal imaging at the University of Chicago Medicine. "These early safety results are promising, but we definitely need longer-term data."
More than 2 million American men have been diagnosed with prostate cancer. Due to prostate specific antigen testing (PSA), most of these cancers are detected early, long before they cause symptoms. Because this cancer occurs primarily in older men, treatment with radiation or surgery is not always necessary as these are man are much more likely to die from another cause than from prostate cancer.
But many healthy men who are relatively young, with a life expectancy greater than 10 years, are not comfortable deferring treatment of a potentially lethal disease. Surgery and radiation can often cure the cancer, but can cause side effects, such as incontinence, impotence and decreased bowel function.
This study enrolled nine men with biopsy-confirmed, low-risk prostate cancers (Gleason score 6 or 7, less than 12 mm of cancer) with an MRI of the prostate showing a small area of cancer. Patients were treated under conscious sedation while lying in an MRI scanner. After injecting a local anesthetic, the physicians inserted a small catheter across the perineum and used it to guide a tiny optical fiber, the laser and a cooling device into the prostate.
Under MRI guidance, the laser was positioned within the cancer and used to heat the area to a temperature that would kill cancer cells. The team checked the temperatures outside the treatment region every five seconds to protect healthy tissue, especially those near critical structures such as the urethra and rectal wall.
The entire procedure took less than four hours. That decreased to 2.5 hours as the team gained experience. The actual heat treatment averaged 4.3 minutes. All patients left the hospital the same day.
No patient had a major complication or a serious adverse effect. Average scores for urinary or sexual function were not significantly different one, three or six months after treatment. No patient had symptoms of rectal wall damage.
Biopsies of the treated areas six months after the procedure found no evidence of prostate cancer in seven of the nine patients (78%). The other two patients had small (2.5 mm and 1 mm) remaining cancers.
These are preliminary results, the authors caution, following a small number of patients for a short time. It will take much longer follow-up, the authors say, to fully evaluate this approach.
Focal laser ablation is the lastest in a series of efforts to target just the cancer cells and preserve normal areas of prostate. It appears to offer "measurable advantages over other ablative therapies for focal prostate treatment, namely that we can visualize our treatment as it is happening," according to the study authors.
Laser-induced heating can destroy cancer cells with little damage beyond the precisely targeted zone. The approach is well suited for prostate tissue and can be carefully watched in real-time with magnetic resonance imaging, which can also monitor the generation and consequences of the heat treatment.
A phase 2 trial of this procedure, sponsored by the National Institutes of Health, is now underway at the University of Chicago Medicine. The physicians hope to enroll 27 patients. Details are available at the NIH's ClinicalTrials.gov website, identifier: NCT01792024.
More information: The paper, "MR Imaging-guided Focal Laser Ablation for Prostate Cancer: Phase I Trial," appears as an early release in Radiology doi:10.1148/radiol.13121652
Journal reference: Radiology
Provided by University of Chicago Medical Center
- The hot -- and cold -- interventional radiology treatments for recurrent prostate cancer Mar 16, 2010 | not rated yet | 0
- More aggressive treatment not necessary for men with a family history of prostate cancer Oct 05, 2011 | not rated yet | 0
- Radiation therapy combo cures prostate cancer long-term Jan 04, 2007 | not rated yet | 0
- Active surveillance can reduce suffering among men with prostate cancer Nov 02, 2012 | not rated yet | 0
- Radiation seeds effectively cure prostate cancer in young men Oct 29, 2007 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Why is zone 1 in liver more prone to ischemic injury?
May 23, 2013 Hi, Is it because around central vein, there is only deoxygenated blood from the vein where as in the periphery there is hepatic artery. Also why...
How can there be villous adenoma in colon, if there are no villi there
May 22, 2013 As title suggest. Thanks :smile:
How can there be a term called "intestinal metaplasia" of stomach
May 21, 2013 Hello everyone, Ok Stomach's normal epithelium is simple columnar, now in intestinal type of adenocarcinoma of stomach it undergoes "intestinal...
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
- More from Physics Forums - Medical Sciences
More news stories
In recent years, microRNAs (miRNAs) and other non-coding RNAs are small molecules that help control the expression of specific proteins. In recent years they have emerged as disease biomarkers. miRNA profiles have been used ...
Cancer May 24, 2013 | not rated yet | 0
Cancer cells spread and grow by avoiding detection and destruction by the immune system. Stimulation of the immune system can help to eliminate cancer cells; however, there are many factors that cause the immune system to ...
Cancer May 24, 2013 | 5 / 5 (1) | 0
Researchers from London's Kingston University have begun a two-year study which could help prolong the lives of people with colorectal tumours.
Cancer May 24, 2013 | 5 / 5 (1) | 0
Transformative research from Western University has identified new hormones in the body which may suppress breast cancer and stimulate the regression of breast tumors.
Cancer May 24, 2013 | 5 / 5 (2) | 0
(Medical Xpress)—Curtin University researchers have found evidence that targeting specific cells in the body can reverse the effects of cancer on the immune system.
Cancer May 24, 2013 | 5 / 5 (4) | 0
Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented today at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality ...
21 hours ago | 5 / 5 (6) | 5
Heart failure accelerates the aging process and brings on early andropausal syndrome (AS), according to research presented today at the Heart Failure Congress 2013. AS, also referred to as male 'menopause', was four times ...
21 hours ago | 5 / 5 (1) | 1
(HealthDay)—Animals make great companions for senior citizens, but elderly people who always drive with a pet in the car are far more likely to crash than those who never drive with a pet, researchers have ...
13 hours ago | not rated yet | 1
(Medical Xpress)—A research team, led by Jeremy Barr, a biology post-doctoral fellow, unveils a new immune system that protects humans and animals from infection.
May 20, 2013 | 4.8 / 5 (31) | 9 |
Until now, little was scientifically known about the human potential to cultivate compassion—the emotional state of caring for people who are suffering in a way that motivates altruistic behavior.
May 22, 2013 | 4.3 / 5 (6) | 6 |
Salamanders' immune systems are key to their remarkable ability to regrow limbs, and could also underpin their ability to regenerate spinal cords, brain tissue and even parts of their hearts, scientists have ...
May 20, 2013 | 4.9 / 5 (7) | 5 |