Prostate treatment on verge of change

Some fifty eminent professionals recently gathered in New York for the third Prostate Colloquium to share their views on how the management of prostate cancer could be improved. Hosted by two charities – the Pelican Cancer Foundation, Hampshire, UK, and the Peter Michael Foundation, California, US, the meeting addressed concerns that many men with low risk cancer are being over-treated – resulting in side effects such as urinary incontinence, sexual dysfunction and rectal symptoms (proctitis, diarrhoea). The colloquium highlighted a discernible shift of emphasis towards the use of imaging for the management of prostate cancer, while leading experts provided an insight into the potential for focal therapy to improve the quality of life for patients after treatment. Mr Mark Emberton, consultant urological surgeon and reader in interventional oncological surgery at University College Hospital, London, described a “sea change in managing prostate cancer” and asserted that imaging provides a solution to avoid current problems with detection and over-treatment of prostate cancer. He commented that instead of giving the majority of patients radical treatment (such as prostatectomy, radiation or hormone therapy), the use of accurate imaging should be used to support a continuum of care that includes active surveillance for low risk patients, and focal therapy for low to medium risk patients, while still detecting high risk disease that needs radical treatment. Delegates discussed the conflicting advice offered to patients who suspect that they have some level of prostate cancer developing, and the potential of MR imaging as an early screening or triage test before intrusive biopsy.

The UK team, led by Mark Emberton, UCLH, and Dr Chris Parker of Royal Marsden Hospital, London, supported a move towards developing focal therapy as a new potential treatment, should screening indicate that some sort of medical procedure is advisable. This new treatment can target cancer areas through light, heat or cold treatments to destroy cancer areas only, while leaving healthy tissue intact. Sarah Crane, chief executive of Pelican Cancer Foundation, commented: “There is concern across the profession that we are over-treating prostate cancer – we know that 80% of men over 80 die with prostate cancer but the lifetime risk of dying of prostate cancer for a man is only 3%. Frequent prostate biopsies are painful and can cause infection, while radical treatment causes significant harm to a man’s lifestyle. In the majority, radical treatment may not even be necessary. A less intrusive and destructive approach is desperately needed for low to medium risk patients. “Greater use of early MRI scanning and focal therapy could revolutionise prostate cancer management. It would avoid the immediate move towards more harmful treatment because of the natural fear attached to elevated PSA results. We believe the current system can overstate the risk and the need for radical treatment.”

HIFU