Published April 20, 2012
With Warren Buffet being diagnosed with Stage 1 (local) prostate cancer, the media’s attention is once again focused on this dreaded disease, which results in almost 250,000 new cases in the U.S every year and more than 30,000 deaths. Since according to the American Cancer Society one in six men will be diagnosed with prostate cancer during their lifetime, many men must decide what to do when that day comes.
Buffet is not a candidate for surgery because of his age, and he has chosen radiation therapy which seems reasonable.
But not all ongoing discussions in the media about the treatment for early prostate cancer are as fair and balanced. A new study just published in the respected journal Lancet Oncology has received an intense media focus leading many to believe that High Intensity Frequency Ultrasound is a preferred treatment for early disease. The treatment in the study targeted cancer lesions found on MRI or prostate biopsies. The study followed 42 men who had received HIFU for a year and found a very low incidence of both impotence and leakage of urine. 95 percent of the men at the end of a year were found to be cancer-free.
If you think this news is too good to be true, you are right.
There is a reason that the US Food and Drug Administration still considers the treatment experimental. A study from Toronto and Australia just last year found a number of cases with extensive residual disease following HIFU and though some of these cases could still be operated on, the side effects were significant. The surgery following failed HIFU is very difficult.
Not only that, but 10 year data from Germany has shown more than a 15 percent recurrence rate of prostate cancer with HIFU, and urinary side effects there approaching 20 percent.
So HIFU is not a cure-all for prostate cancer.
Though it sounds good in theory to pinpoint the disease with one radiological technique and destroy it with another, the reality is that prostate cancer is frequently a multi-focal disease and MRI or biopsy are not a great way to define its extent in the first place. Studies show that 40 percent of cases are found to be more extensive at the time of surgery than originally thought.
So you can start off thinking you’re cured and end up realizing years later that you aren’t.
Of course, since many cases of prostate cancer would not kill you, it would be ideal if we could tell the difference and only remove the prostate gland in truly life threatening circumstances. But we can’t always tell, and with over 30,000 deaths per year, it is frequently better not to take a chance. The best way to know for sure that you got rid of the cancer is still to remove the gland. Luckily for patients, the ability to do so with fewer side effects is improving in the hands of a skilled and experienced surgeon using the latest surgical techniques.
Dr. David B. Samadi is the Vice Chairman of the Department of Urology and Chief of Robotics and Minimally Invasive Surgery at the Mount Sinai School of Medicine in New York City. www.RoboticOncology.com and www.SMART-surgery.com.
Dr. Marc K Siegel is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is the author of The Inner Pulse; Unlocking the Secret Code of Sickness and Health www.doctorsiegel.com
Dr. Samadi and Dr. Siegel are members of the Fox News Medical A Team.