Throw us a bone

by Donna Canada, RN, CURN

New treatments for prostate cancer are in the development pipeline and others are being tested all of the time.

Thermal Ablation

This technique uses an approach opposite to cryoablation—applying heat instead of cold—but the idea is the same. Tissue destroying heat is delivered to the prostate gland, and the urethra is cooled to protect it. Currently, doctors are exploring several different sources of heat, studying their potential to eradicate the tumor, minimize complications and shorten recovery time.

These include:

• High Intensity Focused Ultrasound (HIFU)
• Photodynamic Therapy (PDT)
• Microwave energy
• Radio frequency interstitial tumor ablation (RITA)^3(p358-359)

HIFU has been used primarily in European countries. The procedure is done using carefully guided ultrasound imaging to the treatment area. The patient is under general or spinal anesthesia and a beam of focused ultrasound waves is guided in and used intermittently.

New data presented at the 2010 American Urological Meeting (AUA) show that HIFU as primary therapy for prostate cancer can produce outcomes equal to EBRT. A series of 880 consecutive patients showed steadily improving results as HIFU technology improves, according to Sebastian Crouzet, M.D, Edouard Herriot Hospital, University of Lyon, Lyon, France.

"We have followed some patients as long as 10 years and are reaching results very similar to EBRT, stated Dr. Crouzet. The main issue is that you can repeat HIFU if you see evidence of disease. And if the disease continues to progress, you can add salvage RT to achieve very good control. Disease control and survival rates with HIFU are very encouraging. You also have the advantage that HIFU is very minimally invasive. You don't touch the nerve or the sphincter (area of the urethra for urinary control); therefore, you avoid the side effects of more invasive treatment.⁷

Most of the other thermal ablation techniques are still investigational.

PDT involves administering a photosensitizing drug intravenously and then shooting light of a certain wavelength at the targeted area. This causes a photochemical reaction that is highly toxic to tissue.^{3(p 358-359)}

Provenge for Prostate Cancer

Provenge is classified by the FDA as an autologous (from the same organism) cellular immunotherapy. The cost for one course of treatment with Provenge is $93,000 and Medicare is currently taking a full year to review whether they will cover this new therapy. The FDA approved Provenge in late April 2010 for patients who have prostate cancer that has spread and that has not responded to hormonal treatment. Company studies have shown that taking Provenge added four months to the lives of men with advanced prostate cancer.

"Provenge is designed to train a patient's immune system to attack tumors. It is different from traditional drugs and even biotech drugs because it is made by mixing blood cells from the individual patient with a protein found on cancer cells and an immune system boosting substance.⁸

References:

1. Ellsworth P. 100 Questions & Answers About Prostate Cancer.2nd ed. Sudbury, MA: Jones and Bartlett Publishers; 2009.
2. American Cancer Society, Bostwick D, Crawford ED, Higano C, Roach M, eds. Complete Guide to .Atlanta, GA: ACS Health Promotions; 2005.Prostate Cancer
3. Walsh PC, Worthington JF. Dr Patrick Walsh's Guide to Surviving Prostate Cancer" 2nd ed. New York, NY: Wellness Central; 2007.
4. Scholz, M. Newly Diagnosed Prostate Cancer: Evaluating The Options -- Part 2 Of 3. CRI Insights [online] August 2003 vol. 6, no. 3, Available at: http://www.prostate-cancer.org/pcricms/node/141#ADT. Accessed on September 11, 2010.
5. Vogelzang, 2010 American Society of clinical Oncology Annual Meeting. August 2010 article: Cabazitaxel New Chemo Approved for Advanced Prostate Cancer. Available at: http://www.ustoo.org/PDFs/HotSheets/HotSheet082010.pdf . Accessed on September 11, 2010.
6. Warde, 2010 American Society of clinical Oncology Annual Meeting. July 2010 article: RT Shown Beneficial for Prostate Cancer Subset. Available at: http://www.ustoo.org/Hot_Sheets.asp. Accessed on September 11, 2010.
7. Crouzet, 2010 American Urological Association Annual Meeting Retrieved from July 2010 article: High Intensity Focused Ultrasound Noninferior to External Beam RT for Prostate Cancer. Available at: http://www.ustoo.org/Hot_Sheets.asp. Accessed on September 11, 2010.
8. MSNBC. FDA approves new drug for prostate cancer (press release). Available at: http://www.msnbc.msn.com/id/36853649/ns/health-cancer/. Accessed September 14, 2010.

This article has been reviewed by a member of the Wellness Partners Editorial Board.

Posted September 2010