December 29th, 2007
Dear Dr. Lamm,
My PSA was 5.2 and my prostate biopsy showed grade 6 cancer. I have read about HIFU, but understand that it is not FDA approved. I talked to a man who went to Mexico for the treatment who says it is the greatest. I am getting married in 2 months and have been told that waiting and watching my PSA is an option. Is it reasonable or even safe to go out of the country for HIFU? Why is it not available in the US?
Dear Friend:
HIFU, or “High Intensity Focused Ultrasound” is the newest treatment for localized prostate cancer. It is actually not that new- Government (NIH) funding supported research at Indiana University in the 1950’s that eventually developed into today’s treatment. It is ironic that it is now available in many other countries and not ours, but the FDA generally requires “Phase 3” studies to approve a new cancer treatment. This means that a clinical trial of hundreds of patients is done to compare the standard treatment with new or investigational treatment. These studies are now underway in the US under the approval of the FDA, but will likely take years to complete. Unfortunately, I understand that due to the popularity of HIFU, this arm of the study is full, so there may not be a HIFU option for patients in the US for a long time.
Prostate cancer tends to grow slowly, so we like to look at 15 rather than 5 year survival results to judge the efficacy of a treatment. New treatments that look promising therefore have to be viewed with caution when compared with the gold standard of radical prostatectomy. That said, the early results of HIFU are most encouraging, particularly with respect to the preservation of potency and continence.
Here is how it works: Under anesthesia an ultrasound probe, like the one you had to guide your biopsy, is inserted into the rectum. The prostate is carefully imaged and measured. With a computer controlled robotic arm guided by the surgeon the prostate is destroyed by focusing intense acoustic waves repetitively on small portions of the gland. These focused sound waves work like a scalpel to remove the prostate; heat generated by the waves destroy the gland. These effects can be observed by the surgeon during the procedure as vaporization bubbles in the gland. While this is a surgical procedure that requires special training, it is done like by waves passed through the body, without an incision. It is analogous to shock wave lithotripsy (ESWL) used to break up kidney stones. ESWL revolutionized the treatment of stone disease; HIFU has the potential of doing the same for cancer treatment.
HIFU is only one of many options for the treatment of prostate cancer. Early results looking at post treatment biopsies and PSA suggest that HIFU is as effective as other treatments, and it has the advantage of being an outpatient, “painless” procedure that preserves potency and continence. You should talk to your urologist to help decide which of the many effective treatments is best for you, but if your prostate is not huge and there is no evidence of extension of cancer beyond the prostate, HIFU appears to be a safe and reasonable option.
Thanks for asking,
Don Lamm, MD
Posted in Prosate Cancer, Emerging Treatments | No Comments »
August 17th, 2007
Dear Dr. Lamm,My father, 83 years old (will be 84 in a few months), was diagnosed with Bladder Cancer back in November of 2004. He went through an intial 6 weeks of BCG in spring of 2005 and since then, has had a TURB about every 6 months to remove new tumors. This last time, the urologist suggested my Dad go on maintenance BCG … first 6 weeks, then three weeks more in three months, etc., for the next three years.My Dad currently has trouble making it to the bathroom on time and often has accidents. I don’t really think he could hold the BCG in his bladder for 2 hours … and then, of course, there’s the risk of the bacteria being present should he have an accident …even, say, on the way home from the doctor’s office.
Along with this, he is already weak and tired all the time and I’m very concerned that being a patient for so much of his life might make him even more depressed. I’ve read that the effectiveness of the treatment goes down after age 80, as well, as the body’s immune system is slower as it ages. Would have any thoughts on this that I could share with my father so he could have an informed dialogue with his doctor?
Thank you for your consideration.
Dear Friend,
You are very well informed and are obviously taking great care of your Dad. Keep it up. I would personally not repeat a second 6 week course. If these are low grade tumors, chemotherapy post resection could be the best approach. It does sound like he is one of the many octagenarians who are resistant to BCG. Dr. Konety at UCSF believes that this could be related to the effect of low testosterone on the immune system. If he has no prostate cancer and has a low testosterone, replacement might help both his mood and his bladder tumor control.
Don’t worry about spilling BCG. Unless someone is immunocompromised or has an open wound, BCG is not contagious.
Best regards,
Don Lamm, MD
Posted in BCG Side Effects, Bladder Cancer, BCG (General) | No Comments »
