Ultrasound Prostate Cancer Treatment: Good or Bad?

Ultrasound Prostate Cancer Treatment shows fewer side effects: It’s the most common cancer in men worldwide, as well as a common cause of death among elderly men in the United States and Europe. Prostate cancer is the sixth most-common cause of death from cancer in men worldwide, and although it’s less common in Asia and Africa, in the U.S. and the United Kingdom, it’s the second most common cause of cancer death in men of all ages.

In the U.S., about 250,000 new cases happen every year, leading to about 30,000 deaths; In the UK, about 250,000 men are currently living with the disease, which has led to about 10,000 deaths.

Conventional treatments involve treating the whole prostate — with either radiotherapy or surgery to remove it completely. Cryotherapy, where prostate cancer cells are frozen and destroyed, is also sometimes used.

But because these treatments damage surrounding healthy tissue, these cause distressing side effects — urinary incontinence requiring one or more pads a day (five-25 percent experience this) erections insufficient for sexual intercourse (30-70 percent) and rectal problems, such as diarrhea, bleeding and pain (five -10 percent).

There is thus is a need for new kinds of treatment that safely remove cancerous tissue without damaging surrounding nerves.

A new experimental prostate cancer treatment that uses high intensity focused ultrasound (HIFU) — or sound waves promises to selectively target individual cancer cells — promises to be more effective and to have fewer side effects than conventional treatments, according to a new study published early online in The Lancet Oncology on 17 April 2012.

Doctors at University College Hospital in London have carried out the small first trial using HIFU aimed at small patches of cancer cells on the prostate of 41 patients. The study was designed as a proof-of-concept study.

As an alternative to radical whole-gland removal (radical prostatectomy) in men with localized prostate cancer, HIFU is similar to the option of a “lumpectomy” as an alternative to a full mastectomy in breast cancer.

Killing cancer cells with soundwaves focused to millimeter-accuracy
Doctors at University College Hospital in London conducted the phase 1 study between June 2007 and June 2010.

For the study, Dr. Hashim Ahmed, a urological surgeon at the University College London Hospitals NHS Foundation Trust who led the study and colleagues recruited 42 men with prostate cancer. One man died of causes unrelated to the cancer three months after treatment, so only 41 were included in the analysis.

The men chosen to participate in the study were:

  • 45 to 80 years old
  • With medium- to high-risk cancer
  • Would likely have undergone surgery or radiotherapy down the line

Men who had already received chemotherapy, hormone treatment or radiation therapy were excluded from the study.

Then the doctors proceeded to:
• Use two highly sensitive diagnostic techniques — MRI and mapping biopsies — to enable them to pinpoint the exact location of the cancer lesion or lesions. This isn’t possible using standard diagnostic tests like transrectal biopsy.
• They then targeted these areas with the HIFU device.
• HIFU focuses high frequency sound waves to millimeter accuracy — onto an area the size of a grain of rice.
• The sound waves caused the tissue to vibrate and heat up to around 80 to 90 degrees Celsius.
• Cells were killed instantaneously.

The HIFU ultrasound prostate cancer treatment procedure is performed in hospital under general anesthetic and most patients are back home within 24 hours.

A full year following the trial, the researchers found that:
• About 95 percent of the men were cancer-free.
• None of the patients reported urinary incontinence a year after treatment.
• Only 1 in 10 suffered from poor erections.

Writing in Lancet Oncology, the researchers concluded that “focal therapy of individual prostate cancer lesions, whether multifocal or unifocal, leads to a low rate of genito-urinary side-effects and an encouraging rate of early absence of clinically significant prostate cancer.”

Men who undergo traditional treatment for prostate cancer have a 50 percent chance of achieving the ‘perfect outcome’ or what is known as trifecta status — no urine leak, good erections and cancer control at 12 months after surgery or radiotherapy. In this study, men who underwent the new experimental treatment had a 9 in 10 chance of achieving the trifecta outcome at 12 months.

“The signal from this study is quite strong,” Dr. Ahmed tells Bloomberg. “When you look at the current standard of care, there’s a 1-in-3, or 1-in-2 chance of having the perfect outcome. In this study, after 12 months, it’s a 9-in-10 chance.”

Dr. Ahmed also says:
“This study provides the proof-of-concept we need to develop a much larger trial to look at whether focal therapy is as effective as the current standard treatment in protecting the health of the men treated for prostate cancer in the medium and long term.”

“Our results are very encouraging. We’re optimistic that men diagnosed with prostate cancer may soon be able to undergo a day case surgical procedure, which can be safely repeated once or twice, to treat their condition with very few side effects. That could mean a significant improvement in their quality of life.”

Ahmed also tells Bloomberg that the HIFU ultrasound prostate cancer treatment also be cheaper than other standard treatments:
• Removing the prostate costs about US$7,100.
• The cost of the MRI and mapping is an estimated US$2,400, plus about US$1,600 for HIFU
• Fewer side effects would also lower other health care costs.

Funds from the Medical Research Council (UK), Pelican Cancer Foundation, and St Peters Trust helped pay for the study.

72-year-old Robert Page, from Croydon, UK, one of the patients in the trial says his treatment — done two years ago — was a great success.

“The outcome was very good,” he said. “I was very pleased with the treatment and very happy with the lack of side-effects, particularly when I contrast that with what might have been the case if I’d had one of the other, alternative, treatments.”

But while the initial results were promising, they need to be replicated, Dr. Ahmed acceded. HIFU also needs to be studied long-term and compared with other therapies.

If the ultrasound prostate cancer treatment technology holds up, however, it could also work for other cell-based cancers like breast, thyroid, pancreas and liver, Ahmed enthuses. His team is now seeking funding and recruiting more patients for larger studies.

Professor Mark Emberton, who leads the research program at UCL and UCLH, says: “Focal therapy offers harm reduction — it is a strategy that attempts to redress the balance of harms and benefits by offering men who place high utility on genito-urinary function an alternative to standard care.”

“In fact, the concept is not new — tissue preserving strategies have been used successfully in all other solid organ cancers such as breast cancer by offering women a lumpectomy rather than mastectomy.”

Professor Gillies McKenna, director of the MRC/Cancer Research UK Gray Institute for Radiation Oncology and Biology, is also optimistic, saying: “Clinical trials, like this one supported by the MRC, are a fantastic tool for telling us whether experimental new treatments are likely to be effective in the clinic. If these promising results can be confirmed in a randomized controlled trial, focal therapy could soon become a reasonable treatment choice for prostate cancer alongside other proven effective therapies.”

Filed under: ultrasound prostate cancer treatment