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Radiation Failure on Treating Prostate Cancer

Posted by Ashraf Ali Tuesday, January 25, 2011

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Unlike radiation therapies, ultrasound energy is non-ionizing "clean energy" that does not damage tissue surrounding the target zone. The target zone is approximately 1/8 inch in diameter, which allows greater precision than radiation therapies. Unlike radiation therapy, HIFU treatments may be repeated in the event that the disease recurs locally. HIFU may also be used as a salvage therapy following failed radiation therapy.
The HIFU procedure is performed on an outpatient basis, meaning that a hospital stay is usually not necessary. The procedure is performed under spinal or general anesthesia and typically takes approximately 2 hours. During the procedure, a small probe is inserted into the rectum which generates and emits the ultrasound energy that is precisely targeted to the prostate. Physician will monitor the prostate throughout the procedure using real-time ultrasound images to maximize prostate cancer destruction and minimize injury to other vital tissues.
HIFU treatment for prostate cancer has not yet been approved by the U.S. Food and Drug Administration. However, to date, over 6,000 men have undergone HIFU at over 100 International HIFU Centers throughout the globe. Every year, over 40,000 men with prostate cancer who are treated with radiation have their cancers return. The majority of these men will choose hormonal therapy in an attempt to control their cancer. Hormonal therapy prohibits the production of testosterone in order to slow down the cancer's growth. However, lowering of testosterone may cause side effects such as osteoporosis, increased risk of heart attack, stroke, loss of libido, depression, loss of mental acuity and impotence. HIFU is radiation free and destroys residual cancer in the prostate using clean ultrasound energy. In a small U.S. safety trial, 91% of the participants had a negative biopsy 6 months after the HIFU treatment.
The typical short-term side effects associated with radiation therapy include fatigue and urinary and rectal symptoms. Urinary symptoms may include frequency, urgency, urge incontinence, nocturia and diminished urinary stream. Rectal symptoms may include diarrhea, fecal incontinence, rectal bleeding and rectal urgency. In most cases, the urinary and rectal symptoms are transient. In addition, erectile dysfunction often develops months or years after radiation therapy. Long-term complications are rare and include rectal or urinary fistulas, urinary strictures, hemorrhagic cystitis and proctitis (chronic bleeding from the rectum and bladder) and dysfunctional bladder or rectum due to scarring. There is increasing evidence that men undergoing pelvic radiation are at significantly greater risk of developing bladder and colon cancer.
Salvage radical prostatectomy is also a very challenging technical procedure because of the prostate is embedded in a fibrous scar produced by radiation. Therefore, minimally invasive ablative therapies are gaining increasing acceptance for the treatment of recurrent prostate cancer after failed radiation therapy which is indeed HIFU. Many patients who have had radiation therapy, brachytherapy or external beam radiation experience a rise in PSA have discovered that the cancer is back. These patients may be candidates for HIFU as well, as long as the cancer has not spread to the bone or other organs. Additionally, patients who have a local recurrence after receiving a radical prostatectomy may also qualify for HIFU.

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