Prostate ‘lumpectomy’ treatment is an effective and safer option than surgery for cancer that has returned after radiotherapy

A new study by Imperial College London has shown that targeted treatment to areas of cancer inside the prostate is effective and has low risk of side effects. The study was carried in men in whom the cancer had recurred in after previous radiotherapy. The study is to be presented at the international ASCO (American Society of Clinical Oncology) cancer meeting on 29th May 2020.

Every year, about 10,000 to 12,000 men with prostate cancer have radiotherapy. This is an effective treatment for prostate cancer but about 1 in 7 of them will have a recurrence years later. Patients who have a cancer recurrence contained within the prostate are traditionally offered anti-testosterone hormone treatment. This controls the cancer for 2-3 years before the cancer changes and needs more expensive second- and third-line drugs.

The hormone treatment can cause side effects such as obesity, tiredness, bone thinning and can also increase risk of diabetes and heart disease. The alternative is radical salvage surgery (called prostatectomy) which removes the entire prostate. This type of surgery is not commonly done because the tissues surrounding the prostate are scarred and stuck down due to previous surgery. As a result, 50-100% get urine leakage needing daily pads and 5-10% get rectal injury requiring colostomy and further major reconstructive surgery. Faced with these options, most men choose hormone medication.

Focal therapy uses either sound waves or freezing to selectively target and treat areas of cancer inside the prostate rather than the whole prostate. This is the prostate equivalent of a ‘lumpectomy’ performed for breast cancer. The soundwave technology is called High Intensity Focused Ultrasound (HIFU) and the freezing technology is called cryosurgery. There is no need for cuts to the skin and most men go home the same day and have a quicker recovery than salvage prostatectomy.

This current study is the largest ever with the longest follow-up in 356 patients from UK centres. It shows that the treatment is effective at cancer control with average 6 years of follow-up in this high-risk group of patients where the cancer recurred after previous radiotherapy.

The results show that, after 6 years, 3 out of 4 patients treated with focal therapy had their cancer controlled and did not need hormones or surgery and the cancer did not progress. Cancer specific survival was 97.2%. The procedure is also safe in which less that 1 in 100 patients were noted to have a significant complication. Rectal injury was 0.3% whilst the researchers have shown in another study that urine leak needing pads was 12.5%.

Professor Hashim Ahmed, senior researcher for the study at Imperial College NHS Foundation Trust and Imperial College London, said that “Radiotherapy is effective in most men but for the thousands of men with recurrent prostate cancer after radiotherapy, the options are very limited. Focal therapy for these patients offers a treatment for their cancer that does not carry the high risk of side-effects from traditional hormones or major surgery.”

Dr Deepika Reddy, a urology research doctor, and lead author on the study, based at Imperial College NHS Foundation Trust and Imperial College London, said, “This study provides more evidence that focal therapy should be considered in men whose cancer is suitable for a minimally-invasive approach. Such evidence in combination with well-structured clinical trials will help patients, in partnership with their doctors, work out the most suitable option for them.”

prost8 - new thinking for prostate cancer - image logoProst8 UK is the only prostate cancer charity working solely to promote awareness of the enhanced lifestyle outcomes provided by focal ablation for men with an early stage or recurrent prostate cancer diagnosis.  The charity’s founder Paul Sayer said, “we will launch our high profile Prostate Cancer – Know Your Choices campaign in July of this year to widen awareness of focal therapy for prostate cancer. 

Sadly, right now up to 95% of men with a new diagnosis will not even be told about this treatment option, let alone offered it.  And, too many GP’s and clinicians involved in prescribing treatments for this disease are unaware of this treatment pathway and its efficacy. We are working hard to change this as soon as possible”.  In addition, the charity is actively fundraising to buy and deploy focal therapy equipment into strategic NHS hospitals across the UK to accelerate access to the treatment.

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