Here’s a little quiz: Which whole gland therapy for prostate cancer has the highest risk of recurrence?
- Radical prostatectomy
- Radiation therapy
- Cryotherapy of the whole gland
- HIFU of the whole gland
If you answered radiation, you are correct. According to a recent article, the rate of prostate cancer coming back after conventional external beam radiation is 53% over a 5-year follow-up.[i] These results have been consistently reported for nearly a decade.[ii] Does that seem surprising? It should, especially since radiation treatment is the most commonly used for prostate cancer.
On Feb. 23, 2015, the online newsletter Health Imaging ran an article by writer John Hocter. He wrote, “Men with indolent prostate cancer are prescribed radiation therapy more than any other treatment option regardless of tumor biology, according to a study published in the February issue of JAMA Oncology.”[iii] In fact, 58% of men who have whole gland treatment for their PCa choose radiation; a distant second is radical prostatectomy (RP) at 19%, and only 10% opt for active surveillance (AS).
What is important here is that radiation is being recommended for men who have indolent PCa, meaning disease that is not likely to become life-threatening. The reasons for this are not entirely clear, but one cannot help but suspect economics. Radiation is the most expensive—and most highly reimbursed—of PCa treatments that are covered by Medicare and insurance. Radiation is costly in other respects: while most patients do not have immediate side effects other than fatigue while going through treatment, slow damage to nearby structures means that years after exposure to radiation, many patients begin to experience urinary, sexual and bowel problems. Chances increase of developing what is called “secondary cancer” such as radiation-induced bladder or bowel cancer. If you remember the nuclear disaster at Chernobyl or the more recent earthquake and tidal wave that created a catastrophe at the Fukushima power plant, you know the danger…but rarely associate it with medical radiation.
Hocter points out that more men with early stage, low risk prostate cancer should consider AS. At the Sperling Prostate Center, we support this position. We strongly agree that it makes no sense to go after a mouse with an elephant gun, especially if the “gun” has the largest record of being ineffective, and is known to cause collateral damage over time. More importantly, we offer a middle-ground, focal laser ablation (FLA) for men who don’t want to wait around to see if their PCa is going to increase in size or aggressiveness. Focal therapy using the controlled, precise power of laser is an effective way to treat just the tumor with the lowest risk of urinary and sexual side effects of all treatments. Our patients are liberated from worrying and wondering about what’s happening in their bodies.
We look forward to the day when “overkill” treatments like radiation are used only sparingly, for the patients who most need them. As more patients learn about focal treatments, that day will come sooner than we think.
[i] Martin, N. E. and D’Amico, A. V. (2014), Progress and controversies: Radiation therapy for prostate cancer. CA: A Cancer Journal for Clinicians, 64: 389–407. doi: 10.3322/caac.21250;
[ii] Lukka H, Hayter C, Julian JA et al. Randomized trial comparing two fractionation schedules for patients with localized prostate cancer. J Clin Onc. 2005;23(25):6132–6138.
[iii] http://www.healthimaging.com/topics/oncology-imaging/radiation-therapy-most-prescribed-treatment-prostate-cancer
http://onlinelibrary.wiley.com/doi/10.3322/caac.21250/full
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
