One in eight men will be diagnosed with prostate cancer during their lifetimes. Most of them will be older than 65. Although prostate cancer is the second leading cause of cancer deaths in the United States after only lung cancer, most of the men diagnosed with prostate cancer will not die from it. According to the American Cancer Society, approximately 3.3 million men who have been diagnosed with prostate cancer at some point are still alive today. New treatment options continue to be developed and to improve the odds for those who fall victim to this disease.
For many years, there were three main treatments for prostate cancer: Prostatectomy, removal of the prostate, external radiation, and brachytherapy, a form of internal radiation using implanted radioactive beads. Each of these treatments had significant risks associated with it. Each had a greater than 50% chance of leaving the patient without a functional erection, for example. Newer forms of treatment include hormonal treatment, immunotherapy, and the use of high intensity focused ultrasound (HIFU) to attack the tumor. The ultrasound procedure is non-invasive and is performed on an outpatient basis.
As the name implies, high intensity focused ultrasound uses sound waves to target and kill tumor cells. These are the same sound waves used in diagnostic ultrasounds but at a much greater intensity and focus. The highly focused sound waves pass harmlessly through the tissue surrounding the prostate but increase the temperature of the tumor. When the temperature inside the tumor is high enough, it dies. The primary candidates for use of HIFU are men with early stage prostate cancers whose tumors are localized and have not spread outside the prostate.
As with any other form of medical intervention, there are risks with HIFU. Two of the most significant risks are erectile dysfunction and urinary problems. The frequency of these problems is less than with the earlier treatments, however.
The overall rate of erectile dysfunction following HIFU is about 36%. Most of the men who have this procedure are older and many of them have some level of erectile dysfunction before the procedure. The more significant their level of erectile dysfunction prior to the procedure, the more likely they are to experience a worsening after the procedure. The location of the tumor is also a factor in determining the risk of post-procedure erectile dysfunction. The closer the tumor is to the neurovascular bundle, the structure inside the prostate containing the nerves and blood vessels necessary for an erection, the greater the likelihood HIFU will cause erectile dysfunction.
Immunotherapy uses medications to stimulate the patient’s own immune system to attack prostate cancer tumors. There are different types of immunotherapy. Some involve taking the patient’s own cells and creating a vaccine specifically tailored to the patient. Some cancers have the ability to turn on genes that prevent the immune system from attacking them by tricking it into thinking the cancer is part of the patient’s own body or by making the tumor invisible to the immune system. One immunotherapy option involves turning off those genes and turning the immune system loose. Depending on the specific characteristics of the patient’s prostate cancer, some other gene therapies can be effective in attacking it as well.
In addition to new treatment options, medicine is continually working to improve the older treatments. For example, new technology permits radiation beams to be more narrowly focused than ever before so that there is less damage to normal tissue when beam radiation is used.
The prognosis for patients with prostate cancer continues to improve as new discoveries are made and older treatments are improved. That said, prostate cancer is likely to remain with us for the foreseeable future.
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