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Treatment for prostate cancer crucial choice

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How many angels can dance on the head of a pin? No one knows. Nor has anyone, to this point, found the answer to treating prostate cancer. Now, a treatment called high-intensity focused ultrasound (HIFU) is available. So, could this procedure be the ultimate way to cure prostate malignancy?

In North America, every three minutes, a man is diagnosed with prostate cancer, and every 15 minutes, a man dies from it. The major problem has always been which men should be treated, and when should doctors follow a wait-and-see policy?

Waiting to see what will happen has never been a logical move any time cancer is diagnosed. The result is normally the spreading of the malignancy and eventually death. But prostate malignancy, unlike other cancers, doesn't always follow this rule.

For instance, some prostate cancers are "pussycats," only slightly cancerous, growing slowly and remaining localized for years. In fact, a 70-year-old male with prostate cancer may live for 15 years before the cancer becomes lethal, and by that time he may have died of something else. So why should doctors subject him to the devastating complications often associated with various forms of treatment?

The huge dilemma facing doctors and patients is some prostate cancers are ravenous "tigers," growing rapidly and out to kill. Today, tests are available that help to separate tigers from pussycats, but they're not 100 per cent accurate. So, when and when not to treat is often a life-or-death decision that requires the wisdom of Solomon.

Today, men who have prostate cancer face a number of confusing options. Radical prostatectomy, in which the entire prostate gland is surgically removed, has been considered the gold standard of treatment. But it's major surgery with the risk of urinary incontinence and impotence.

Urinary incontinence is encountered less frequently now than in the past, as surgeons try to spare the nerves controlling urination during the operation. But many readers have told me they would never have consented to the surgery if they had been fully informed they might spend their final years in diapers.

Other therapies include external radiation therapy, insertion of radioactive seeds into the prostate gland, hormone treatment, chemotherapy and freezing the prostate gland. But none is without complications.

So what is HIFU, and how good is this therapy? HIFU uses energy to destroy tissue. I'm sure many of you remember using a magnifying glass to concentrate the sun's rays on a piece of paper and see it catch on fire.

Today, HIFU accomplishes the same thing, but uses complex computer-assisted equipment. Patients are given a spinal or general anesthesia. A rectal probe is then inserted that allows the doctor to outline the prostate gland. But the same probe also enables the surgeon to deliver intense thermal heat, up to 85 C (185 degrees Fahrenheit), to destroy the gland and its malignancy. In effect, HIFU cooks malignant cells to death.

Following surgery, patients are often sent home the same day. A urinary catheter to drain the urine is needed for a few days. During that time, destroyed prostate tissue is discharged through the catheter while healing takes place.

Patients who have an extremely enlarged prostate that has been causing obstruction of urinary flow may require an operation to remove the blockage. But this surgery, if needed, can be done at the same time as the HIFU procedure.

HIFU is not for every patient. The malignancy must be confined to the prostate gland and tests such as the Gleason score, (a scale to judge the severity of the cancer), should be low.

Critics say not enough time has elapsed to know whether there will be a low or high recurrence rate of cancer. There are also insufficient data to know how many men will suffer from urinary incontinence and impotence.

Currently, HIFU is available in some Canadian cities, but is not covered by provincial medical insurance plans. The FDA (Food and Drug Administration) in the U.S has not approved HIFU until more long-term data are available. But for those who can afford it, being able to pay $20,000 and go home the same day is an appealing prospect.

For more information, call 1-877-787-5906.

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Republished from the Winnipeg Free Press print edition March 8, 2013 A19

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