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Are there non-invasive treatment options for prostate cancer?

William Orovan, MD, MBA, FRCSC, FACS (Urologist)

Prostate cancer is the most commonly diagnosed cancer in Canadian men. The Canadian Cancer Society estimates that 24,600 new cases of prostate cancer will be diagnosed in Canada this year.

Since the introduction of prostate specific antigen (PSA) testing more than two decades ago, earlier diagnosis of the disease has encouraged discussion on reducing invasiveness of treatment and its side effects.

Because prostate cancer is relatively slow-growing in most cases, aggressive treatments such as surgery (radical prostatectomy) or radiation (seed implants or IMRT) may not be appropriate in many of the cases diagnosed. However, less invasive surgical techniques such as laparoscopy, even robot-assisted, may still be associated with side effects and complications including incontinence and impotence. Radiation therapy techniques have also improved with the development of seed implants, but the use of these techniques is limited to low grade cancers in smaller prostates.

The search for less invasive, more easily tolerated methods of treatment has led to wider acceptance and availability of ablative technology, which involves either freezing within the prostate or applying heat ablation, as with High-Intensity Focused Ultrasound (HIFU). The latter technique is proving an increasingly attractive option for men who require active intervention but wish to avoid surgery or radiation. HIFU is performed as a walk-in procedure, is a one-time treatment taking approximately two hours and is associated with minimal post-treatment side effects.

HIFU has been utilized as a treatment option for prostate cancer in Western Europe, particularly in Germany and France, for nearly 15 years, and many thousands of patients have been treated successfully.

It has been available in Ontario since May 2005, and provided at Cleveland Clinic Canada by Maple Leaf HIFU since May 2010. While the technique has been approved by Health Canada, provincial insurers, including the Ontario Health Insurance Plan, have not yet agreed to cover the cost for the treatment.

Treatment results have been very encouraging to date. Western European studies document cure rates approaching 80% after five years in low-grade cancers. These rates are comparable to the cure rates for the more invasive techniques currently used in Canada and across North America. The major side effect of prostate cancer treatments, incontinence, occurs far less often with HIFU than with radical prostatectomy. Incidents of erectile dysfunction are similarly fewer than with surgery, though less markedly so.

Patients who are not cured by their initial HIFU treatment can be retreated, and also remain candidates for external beam radiation therapy or even radical prostatectomy. The fact that HIFU keeps all options open makes it more attractive to patients who are overwhelmed by the volume of information in books, magazines and websites, which present confusing and often conflicting data. For more information about Maple Leaf HIFU, visit www.hifu.ca or call 877.370.4438.