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A New Treatment for Men with Recurring Prostate Cancer Following Radiotherapy

Radiotherapy is one of the most common treatments currently prescribed for prostate cancer in the UK.  However, following radiotherapy treatment, there is a 1 in 5 chance that prostate cancer will return even if the treatment was initially deemed successful. In the past, men in this unfortunate situation have been treated with a palliative care strategy which involves careful monitoring and hormone therapy.

The hormones used as part of a palliative care strategy suppress testosterone which helps to keep prostate cancer under control for up to 3 years. However, long term use can lead to adverse medical conditions such as heart disease, diabetes, thinning of the bones and weight gain.

The alternative is a prostatectomy (surgical removal of the prostate) which generally causes significant problems and side effects. The tissues within and surrounding the prostate gland become “sticky” with considerable scarring and fusion as a result of the initial radiotherapy. As a result, side effects can include incontinence, bowel damage (which can lead to a colostomy) and a loss of erectile function.

The Alternative: High Intensity Focused Ultrasound (HIFU)

HIFU is a highly effective and minimally invasive treatment option approved by NICE and the NHS which has so far been primarily used to treat early stage treatable prostate cancer.

It is now accepted as an alternative treatment in the setting of radio-recurrent prostate cancer following radiotherapy as a result of highly successful studies over a number of years and has recently become approved for general use, albeit available only in a very limited number of hospitals.

In this form the treatment is known as Salvage HIFU. HIFU treatment (also known as focal therapy) limits the areas it targets by overlaying precision MRI scans and live ultrasound imaging to locate and localise cancerous tissue within the prostate gland. This way, less tissue becomes damaged and side effects occur less often whilst ensuring that the cancer is treated.

The Groundbreaking Study by Imperial College London

A recent study and trial by Imperial College London involved 356 men with recurrent prostate cancer following radiotherapy who were treated using refuge focal therapy. After they received the treatment, 3 in 4 of the men did not experience any disease progression in the following 6 years and did not need any hormones or invasive surgery. Meanwhile, less than 1 in 100 men experienced any significant complications. Only 0.3% suffered some minor rectal injury.

In addition to the 12,000 men each year with early-stage prostate cancer who could be treated with focal therapy, there are at any time a further 10,000 men in the UK with recurrent prostate cancer following radiotherapy who could also be suitable for this treatment.

Currently, there are very few NHS hospitals and private centres that offer HIFU. This is expected to increase in the next couple of years as the benefits of this treatment are better proven, and as men become more aware of it, along with the ongoing campaigning work of the Prost8 UK charity.

How It Works

Roughly two-thirds of men who have localised failure following radiotherapy develop unifocal cancer (one place) or unilateral cancer (one side) and the main location of the recurrence is usually the main (index) lesion prior to radiotherapy.

Localised prostate cancer is quite often multifocal and consisting of an index lesion which drives the cancer. Over time, this can lead to metastatic cancer spreading out from the prostate to other parts of the body. Secondary lesions are usually cancers that lie dormant and are deemed as insignificant.

In fact, more than 89% of recurrent cancer following radiotherapy grows from the cancer remnant in the location of the original index lesion. The majority of the time, secondary lesions are successfully treated by radiotherapy.

What’s Involved During HIFU Treatment?

Before receiving HIFU treatment, patients will have an MRI scan and usually a biopsy taken from the prostate. This helps the medical team to ensure they are only targeting the area of the prostate that’s affected by the cancer.

A single session of HIFU treatment can last up to 3 hours, although, the exact time will depend on the size of the prostate and how much of it is being treated. Once under a general anaesthetic, the surgeon and medical team will place a small hollow tube (known as a catheter into the bladder). The HIFU probe will then be placed in the rectum.

This probe will then release highly controlled ultrasound waves that generate pinpoints of heat accurately targeting just the cancerous tissue and a small margin around it within the prostate. During the treatment, the surgeon will use the ultrasound scanning to ensure that the probe is correctly positioned. The probe only treats small areas at a time (about the size of a small grain of rice) so the treatment will be staged and energy redirected until all the cancerous cells have been targeted and destroyed.

Recurrent Prostate Cancer and Why We’re Campaigning

Prost8 UK is the only prostate cancer charity working solely to promote awareness of the enhanced lifestyle outcomes provided by focal ablation for men with early-stage or recurrent prostate cancer.

Currently, more than 95% of men with a new prostate cancer diagnosis will not even be told about this treatment option, let alone offered it. Too many GP’s and clinicians involved in prescribing treatments for this disease are unaware of this less invasive treatment pathway and its efficacy. But, Prost8 UK are working hard with forward thinking urology specialists nationwide 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 create focal therapy centres of excellence and so accelerate access to the treatment.

To support the campaign and help Prost8 UK to help up to 20,000 men each year in the UK, then please donate today via the website (www.prost8.org.uk), or by calling 0203 858 0848.