A Promising Surgical Option for Prostate Cancer in Older Men

Preserving healthy tissue akin to breast cancer’s lumpectomy, this alternative surgery shows potential.

When envisioning prostate cancer surgery, the radical prostatectomy likely takes center stage—removing the entire prostate gland along with the seminal vesicles producing semen. Yet localized prostate cancer, confined within the prostate, presents an alternative surgical path.

Focal therapy, a novel approach, targets solely the cancerous prostate portion, leaving the remainder of the gland untouched. Its objective is to eradicate “clinically significant” tumor tissue, the cancer that would metastasize if untreated. Although a small chance of residual cancer exists post-treatment, focal therapy boasts reduced risks of erectile dysfunction and urinary incontinence, typical after radical prostatectomy. Emerging evidence solidifies its efficacy.

Recent research indicated comparable cancer outcomes after five years of follow-up for 1,379 men subjected to focal therapy or radical prostatectomy. With an average age of 66, these men underwent high-intensity focused ultrasound (HIFU), utilizing intense ultrasound waves to elevate tumor temperatures, eradicating cancer.

Now, the same research team’s findings underline focal therapy’s viability for older men combating prostate cancer. This study, assessing outcomes for 649 men aged 70 and above across 11 UK sites, yielded promising results. Approximately two-thirds displayed an intermediate risk of cancer spread, while the remaining third harbored aggressive, high-risk tumors.

Employing HIFU, or cryotherapy, which freezes cancer, all participants underwent treatment. The study prioritized “failure-free survival,” where treated individuals avoided prostate cancer-related mortality or aggravated disease necessitating further intervention.

Unveiling the Insights

Following follow-ups extending to five years, 96% of participants remained alive, with an 82% overall failure-free survival rate. No disparities emerged between HIFU and cryotherapy outcomes. For high-risk cancer, the failure-free survival rate dropped to 75%, in contrast to the 86% among intermediate-risk patients.

Crucially, 88% of high-risk individuals and 90% of intermediate-risk individuals circumvented hormonal therapy, an unpopular treatment due to its side effects. The authors conclude that focal therapy could be a valid option to manage prostate cancer in older men as effectively as radical prostatectomy.

While the study highlights encouraging outcomes, potential complications linked to focal therapy exist. A small fraction experienced urinary tract infections, and some grappled with treatable urinary retention. Notably, functional post-surgery aspects like erectile dysfunction or urinary incontinence weren’t assessed. However, growing evidence from other studies implies long-term urinary incontinence post-focal therapy is rare.

Harvard experts emphasize that more focal therapy evidence remains essential. Dr. Boris Gershman, a urologist at Beth Israel Deaconess Medical Center and Harvard Medical School assistant professor specializing in prostate and bladder cancer, notes, “Despite promising results… long-term outcomes following focal therapy must still be evaluated to gauge its comparison with radical prostatectomy or radiation therapy.” Additionally, further research can refine focal therapy’s suitability for specific prostate cancer types, guiding comprehensive treatment strategies.

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