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Using high energy ultrasound beams to destroy prostate cancer tumors may be as effective as surgery or radiotherapy, but with fewer side effects.

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A new study, carried out at six hospitals across the U.K., tracked 625 men with prostate cancer who received a type of treatment called high-intensity focused ultrasound (HIFU) (Eur Urol 2018; doi:10.1016/j.eururo.2018.06.006). The research is the largest ever study of HIFU treatment used to target prostate tumors.


The findings, from a number of institutions including Imperial College London and University College London, found that after 5 years the cancer survival rate from HIFU was 100 percent. Approximately 1 in 10 men needed further treatment. The cancer survival rate from surgery and radiotherapy is also 100 percent at 5 years.


The research also showed the risk of side effects of HIFU, such as urinary incontinence and erectile dysfunction, were lower than other treatment options.


"Although prostate cancer survival rates are now very good, the side effects of surgery or radiotherapy can be life-changing," said Professor Hashim Ahmed, PhD, lead author from the Department of Surgery and Cancer at Imperial. "Some patients are left requiring multiple incontinence pads every day, or with severe erectile dysfunction.


"We need to now focus on improving the quality of life for these men following treatment," he added. "This latest trial of focal HIFU-which is the largest and longest study of the treatment to date-suggests we may be able to tackle the cancer with fewer side effects."


Treatment Options

Prostate cancer treatments include surgery to remove the gland, or radiotherapy, which uses radiation to the entire prostate. However, these treatments can cause collateral damage to surrounding sensitive tissues like nerves, muscles, urine passage, bladder, and rectum.


Surgery and radiotherapy to the entire prostate are effective treatments but can lead to long-term risk of urinary problems, like incontinence, between 5-30 percent. They also carry a risk of erectile dysfunction between 30-60 percent. Radiotherapy can also cause rectal problems like bleeding, diarrhea, and discomfort in 5 percent of patients.


HIFU is a newer treatment, performed under general anesthetic, which delivers beams of high energy ultrasound directly into the prostate gland via a probe inserted in the rectum. This allows a surgeon to precisely target tumor cells within the gland to millimeter accuracy, with less risk of damage to surrounding tissues. There are no needles or cuts to skin.


Study Details

In the new HIFU study, conducted on men with an average age of 65 and whose cancer hadn't spread, the risk of urine incontinence (defined as requiring pad use) at 5 years after the treatment was 2 percent, and the risk of erectile dysfunction 15 percent. The team noted the results include patients with medium- to high-risk cancer.


The scientists also tracked the number of patients who needed further treatment following HIFU (such as surgery or radiotherapy) to treat any cancer cells that had returned. They found 10 percent of patients needed further treatment by 5 years, which is comparable to a number of patients needing further treatment after surgery or radiotherapy (5-15%).


The team added that prostate cancer patients should talk through all possible treatments with their health care team so they can consider their options fully.


Further follow-up trials are needed to track progress of the patients after 10 years, as well as trials that directly compare HIFU with surgery and radiotherapy.


Anthony Murland underwent HIFU treatment last year to treat his prostate cancer. "I first heard of the treatment from a friend, who had the procedure a few months before. My GP hadn't heard of HIFU, but was very interested, so I ended up educating him about it. He then referred me for the treatment.


"I liked the sound of the treatment as it seemed the least-invasive option, with low risk. The treatment was over in a day-I went in first thing in the morning and was out by the evening. I didn't have any pain, but needed a catheter for 5 days, which was a bit uncomfortable. I'm closely monitored by my GP, and so far the cancer has not returned."


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