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Men who are diagnosed with prostate cancer are typically asked to choose between two alternatives, active surveillance and radical surgery.
Active Surveillance and Radical Prostatectomy Compared
Active surveillance, which is also known as expectant management, is an approach to prostate cancer that involves putting off therapy until there are signs the disease has progressed. This isn't quite the same thing as the older approach of watchful waiting. In active surveillance, there is a recognition that if the tumor is clearly defined, if is well "differentiated," then it is relatively easy to determine when it has begun to spread. Sometimes prostate cancer simply never spreads, so it is thought better not to put men through treatments (described below). "Watchful waiting" was more of a decision not to treat men who are so old that they are likely to die of something else before they would succumb to prostate cancer.
Radical surgery, or radical prostatectomy, means removing the prostate and surgically reconnecting the urethra to allow the flow of urine. Prostatectomy is usually followed by radiation. Sometimes it is possible to perform "nerve-sparing" surgery, but often the surgery itself results in the need to use sanitary pads or a catheter to urinate, and loss of erectile function. Men are often put on "chemical castration" to stop the secretion of testosterone, which accelerates the growth of prostate cancer cells the surgeon missed, or even actual surgical castration if the drugs used to suppress testosterone secretion or to block the release of testosterone are ineffective.
Prostate cancer patients are often given drugs to stop the spread of cancer to bone. These drugs work by stopping the normal processing of breaking down and remodeling bone in order to stop bone pain and fractures. However, they cause calcium to stay in the bones, and can cause dangerously low calcium levels in the bloodstream.
HIFU as an Intermediate Step in Prostate Cancer Treatment
High-intensity focused ultrasound was developed as an alternative for men whose cancer merits more than watchful waiting or active surveillance, but whose cancer is not so advanced that the doctor is forced to recommend radical prostate surgery.
What is high-intensity focused ultrasound, also known as HIFU?
In this method of prostate cancer, a probe generates ultrasound that heats just one lobe of the prostate gland to 195 degrees Fahrenheit (about 95 degrees Celsius) for two to three seconds, leaving surrounding tissue unaffected. The brief exposure to high heat kills cancer cells, but leaves the rest of the prostate intact. The entire procedure takes 20 to 90 minutes.
There are several advantages to HIFU for men who have prostate cancer. When HIFU is used for ablation of the entire prostate gland:
- 99 percent of men remain continent.
- 92 percent of men are cured of the cancer.
- 70 percent of men retain normal erectile function.
When HIFU is used for removal of just the cancerous part of the prostate gland:
- 95 percent retain erectile function, and
- 89 percent achieve the "trifecta," normal erectile function, no need for diapers or sanitary pads, and no cancer at 12 months.