Article: Shining a light on Prostate Cancer

The_Conductor

http://www.timesonline.co.uk/tol/life_and_style/health/features/article6895791.ece

Before Andrew Lloyd Webber announced this week that he was suffering from the “early stages” of prostate cancer, one of the treatments that he might have discussed with his doctors would have been robotic radical prostatectomy — the removal of the entire prostate gland using keyhole surgery. However, the prognosis is rather bleak — a 5-20 per cent chance of suffering from incontinence and a 30-70 per cent chance of impotence.

The composer would do well to cast his eyes over a piece in last week’s issue of the prestigious Journal of the American Medical Association, which has shocked prostate cancer specialists. The robotic treatment — much favoured over the past few years for being less invasive and offering quicker recovery times — seems to have failed to live up to its hype. The report says that a study of nearly 9,000 prostrate cancer sufferers between 2003 and 2007 found that robotic surgery produced a higher risk of incontinence or impotence compared with open surgery.

But it’s not all doom and gloom: a pioneering technique being trialled by Dr Mark Emberton, a consultant urologist at the University College Hospitals, London, is just starting to report some fascinating results. Dr Emberton and his colleague Dr Hashim Ahmed have been looking at how “focal therapy”, which targets the cancerous cells only and leaves the remaining prostate intact, can help to reduce these side effects.

The technique has been dubbed “the male lumpectomy”, and the reason that Dr Emberton is such a keen advocate is that when the prostrate is taken out, robotically or with open surgery, the treatment often damages the muscles that control urine flow and the nerves that affect sexual function.

“The prostate is the only organ that we insist on removing totally when we find cancer within it,” Dr Emberton says. “The average prostate cancer is 2ml in volume, while the prostate is 35ml in volume. So when you treat someone by removing the whole prostate you are actually removing something that is 5 per cent cancer cells and 95 per cent normal, healthy tissue.”

Dr Emberton uses MRI scans to map the prostate accurately, and then uses high-intensity focused ultrasound (HIFU) or photo dynamic therapy (PDT) on the cancerous cells. In layman’s terms this means that he blasts away the cancerous cells using sound waves or light waves, leaving the rest of the prostate intact. “With HIFU the sound waves are concentrated to an area roughly the size of a grain of rice,” Dr Ahmed says. “That area gets heated to about 80-90C and that’s enough to kill the cells in that area only. You can kill as little or as much tissue as you want without damaging anything else.”

Dr Emberton and Dr Ahmed have recently completed the first formal study into focal therapy, using 20 men with early-stage prostate cancer. “Nobody knew what would happen if you preserved the healthy prostate tissue,” Dr Emberton says. “There have been some informal studies which suggested you could get good results but this was the first prospective, externally audited trial in the world.”

They found that 95 per cent of the men who took part were able to achieve an erection within one month of the operation and that 95 per cent also remained continent — astonishing figures compared with those for radical prostatectomy. The other benefit is that the process takes just over an hour under general anaesthetic, which means that the patient is usually in and out of hospital within the day. With a prostatectomy patients usually spend two to three days in hospital and require a recovery period of up to six weeks.

Dr Emberton and Dr Ahmed announced their results at the Congress of the European Association of Urology in Stockholm earlier this year, and since then a number of other focal therapy trials have been set up around the world and their own programme has been expanded to include Basingstoke Hospital.

They are at present working on recruiting 43 men for a second study. “Our results did cause a bit of a stir,” says Dr Ahmed. “We were surprised by how quickly the function returned after treatment. We never expected such a quick recovery.” If all goes well with their second study, says Dr Ahmed, they hope to be able to roll out treatment to hospitals in Bristol, Derby, Hull, Oxford and Birmingham.

“A lot of these investigations have been patient driven,” says Dr Emberton. “Patients are saying to us, ‘Why can’t you investigate in the traditional way and just treat the cancer? If I had colon cancer you wouldn’t remove the whole colon, would you?’ I had one patient the other day who was very angry about the way we treat prostate cancer. He couldn’t make sense of it at all.”

Alan Johnson, 56, who had prostate cancer diagnosed a few years ago, agrees. “The specialist said to me, ‘Don’t worry, we’ll whip it out, stick it in a jar and you won’t have to worry about it’, but I spoke to a friend who’d had his prostrate removed and although he hadn’t had too much of a problem with incontinence — just a few drips in the morning — he hadn’t had an erection since the operation.”

Mr Johnson was just weeks into a new relationship after the breakdown of his marriage. “I wasn’t ready to be losing my sexual function,” he says. So when he heard about Dr Emberton’s trials he signed up without hesitation.

“It has been absolutely fantastic,” Mr Johnson says. “I was in and out, and back at work the following day with no side effects to speak of. It was so straightforward and easy for both the patient and for the NHS as there’s no follow-up drugs needed. Once you’re done, you’re done.”

Because it is in such early stages of research some questions do remain. The most obvious is the long-term cancer control rates. Out of the initial 20 men in Emberton’s study, two displayed signs of residual cancer after treatment. It was microscopic and of low grade, so one chose to leave the cancer and observe it, and the other chose re-treatment and is now clear.

Dr Emberton is philosophical. “While this treatment holds great promise, it is new and we do not know the long-term results yet,” he says. “But I am very hopeful. It’s a little like when it was proposed that women didn’t need a mastectomy for breast cancer. At the time there was outrage. I think the same story will hold true for prostate cancer.”

Anyone interested in putting himself forward to join a focal therapy trial should e-mail Dr Ahmed on Hashim.ahmed@ucl.ac.uk

Prostate cancer: the facts

What is it?

A cancer in men affecting the prostate gland, an apricot-sized organ that sits below the bladder. The prostate produces the fluids that carry sperm.

Who gets it?

One man in eight has prostate cancer diagnosed. Over the past 30 years prostate cancer rates in Britain have tripled, but this is a result of improved detection and increased longevity.

Main risk factors?

Apart from age, both genetics and ethnic background play a part. Up to 10 per cent of cases are caused by inherited genes. Black Caribbean or black African men are twice as likely to get prostate cancer.

Can it be prevented through diet?

There is no conclusive evidence, but recent reviews of research have indicated that foods containing lycopenes (mainly tomatoes) have a protective effect. The Prostate Cancer Charity says that cutting down on animal fat and eating more fruit and vegetables may lower the chances of prostate cancer developing or spreading.

What is the standard treatment?

There is still much debate on this issue. The balance and timing of surgery, radiotherapy and chemotherapy vary according to the stage at which the cancer is detected and how fast it appears to be growing.

chocciebutton

I lost my Dad on the 10th of September to Prostate Cancer. I would advise all males to be screened. It can be cured, the Prostate is only a gland, and can be removed, but if not caught on time, it then spreads to the bones, my Dad was dead within 8 weeks. Do yourself a favour lads.:(

moncai

http://www.irishtimes.com/newspaper/health/2009/0929/1224255431913.html

This was a letter put into irish times a few months ago, it's just a story from a gentleman who dealt with prostate cancer and overcame it successfully.

Condo131

Michael Murphy also appeared on the Late Late and while he seems to be doing fine with PCa, he didn't paint a very rosy picture of his side-effects.

Here's a more optimistic story from the Sunday Independent: