newsobserver.com | Duke cancer therapy keeps prostate on the job

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http://www.newsobserver.com/news/story/973502.html

The

latest trend in prostate cancer therapy is targeted therapy that treats only

the diseased part of the prostate. In theory, leaving the healthy part of the

prostate undisturbed avoids trauma that can cause impotence and incontinence.

Both are common side effects in prostate cancer treatment.

Here are

two options used as " focal therapies " for prostate cancer. Many

medical centers consider focal therapy experimental and offer it only to

patients participating in research studies.

FOCAL

CRYOSURGERY: This treatment involves using a fine-gauge needle to inject

freezing gas into the diseased part of the prostate gland. Imaging equipment is

used during the procedure to ensure precise placement of the gas.

HIGH-INTENSITY

FOCUSED ULTRASOUND (HI-FU): This treatment directs targeted ultrasound waves to

the diseased section of the prostate, creating heat that destroys cancer tissue.

Doctors

think such an aggressive approach is one reason more than 99 percent of

prostate cancer patients are alive five years after diagnosis. Both advocates

and critics of focused therapy say techniques that treat only part of the

prostate may not be as effective.

" Before

there's a bandwagon to them, I think they need to be studied, " said Dr.

Raj Pruthi, director of urologic oncology at UNC Hospitals' Lineberger Comprehensive

Cancer Center.

He said Lineberger doesn't do any focused therapy for prostate cancer now, but

will soon begin a clinical trial. Doctors from UNC-Chapel Hill attended the

Duke workshop.

Ten

percent to 25 percent of men with prostate cancer have bladder control problems

two years after surgery or radiation therapy, according to research compiled by

the Prostate Cancer Foundation. Impotence is even more common; up to 80 percent

of men report problems after surgery or radiation. Some men's symptoms get

better in time; other patients are never the same.

Recent

studies show that men treated with focal cryosurgery fare considerably better.

Up to 90 percent of men who have just one side of the prostate frozen are

potent after treatment. Incontinence troubles about 10 percent. No long-term

data are available about rates of cancer recurrence.

Pruthi

said doctors and patients who are concerned about complications should keep in

mind that there is already one approach with no side effects: doing nothing.

Prostate cancer typically grows so slowly that men with early-stage disease

sometimes forgo treatment and monitor their cancer. Older patients are often

told they may die with prostate cancer, but not from it.

Less radical choices

Dr.

Polascik, a Duke urologic oncologist and specialist in focal

cryosurgery, said most men want less radical treatment options with fewer side

effects and said cancer specialists must try to provide them.

All men

with prostate cancer aren't good candidates for focal therapy. Men with cancer

throughout the prostate gland could not benefit from it, Polascik said. But a study

done at Duke suggests that about one in five men have cancer on only one side

of the gland, and Polascik said those men could benefit.