Curiosity is, well, a curious thing. The philosopher Thomas Hobbes dubbed it “the lust of the mind.” After all, from birth onward the brain has a constant appetite to know stuff. In a New Science article, science writer Dan Jones states, “Curiosity is the driving force behind science, exploration and discovery.” It may occur as a question that just pops into your head, often seeming random and out of nowhere. Whether the content is inconsequential or hugely important doesn’t matter as long as the brain is satisfied with an answer.
Curiosity about the use of focal prostate cancer (PCa) treatment brought together an international team of urologic and radiologic research luminaries. They hail from diverse institutions like University College London (England), Martini-Klinik Prostate Cancer Center (Germany), Brigham & Women’s Hospital (U.S.), Humanitas Research Hospital (Italy), University of Michigan (U.S.) and more.
The title of their May 2023 published paper[i], “Contemporary patterns of local ablative therapies for prostate cancer at United States cancer centers,” sparked my own curiosity. As a practitioner of focal therapy in private practice, I wondered what this team had discovered about the larger medical world of academic and other medical centers here in the U.S. Which patients are most likely to receive hospital based focal therapy, and what kind of hospital centers are most likely to deliver it?
Based on 11,278 patients in the National Cancer Database between 2010-17, all of whom had local tumor ablation in a hospital setting, here’s what the authors found:
- 78.8% had cryotherapy, 15.6% had laser, and 5.7% had other (including HIFU)
- Men who were more likely to receive focal ablation had intermediate-risk PCa, and less likelihood of 10 years’ life expectancy[ii]
- Most were older, between 71-89 years
- Patients tended to have Medicare insurance and an average income less than $48,000
- Local ablative therapy was less likely to be performed at academic/research facilities.
Thus, in the Medicare-insured population, “Local ablative therapy for PCa treatment is more commonly offered among older and comorbid patients.” In other words, the study population in general would not have been considered good candidates for prostate surgery/longer period under general anesthesia because of their age or co-existing health problems such as cardiovascular disease, diabetes, etc. Also, the large gap between the nearly 80% of patients who have cryo vs. 15.6% who had laser is readily explained by the fact that cryo, guided by ultrasound, is generally done by urologists—the majority of physicians who treat PCa—whereas laser is MRI-guided and generally done by radiologists. Finally, the
fact that the study group was largely composed of intermediate-risk patients speaks to the growing trend toward recommending Active Surveillance to younger, low-risk patients (in order to avoid the side effect risks of radical surgery or radiation). Therefore, focal cryo is a good choice for older, intermediate risk patients based on its safety, effectiveness, minimal invasiveness, readily available for urologists to offer, and relatively low cost from a reimbursement standpoint.
The article satisfied my curiosity about what’s going on in U.S. hospital centers with regard to focal therapy. However, the analysis conducted by the research team excluded doctors like myself who, in private practice, specialize in outpatient focal therapy outside of a hospital or academic center. The authors are well aware that there’s an entire PCa population absent from the profile they created. In their conclusion, the authors note, “Future studies should investigate the uptake of these technologies in non-hospital-based settings…” like our own Center.
I was curious about the national patterns of focal treatment and those patients who don’t come to us. However, I know and understand our Sperling Prostate Center patients. Unlike the demographic described above, our patients tend to be younger and healthier, and have life expectancy well beyond 10 years. They lead active lives—many are still working—and want their PCa treated without potential risks to their lifestyle and quality of life. They don’t like the idea of PCa possibly progressing while on Active Surveillance, so they want an option that destroys the primary tumor (index lesion) while preserving sexual and urinary function. We currently offer three excellent focal treatments: Focal Laser Ablation, Exablate Prostate (MR-guided focused ultrasound), and TULSA-PRO.
For now, the authors’ insights have satisfied my curiosity. Next, I want to ask when these or other analysts will turn their research curiosity to focal therapy at centers like ours, and the patients who come to us for their treatment. I hope it will be soon, as it will round out the patterns of focal treatment not covered by this study.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Koelker M, Labban M, Frego N, Meyer CP et al. Contemporary patterns of local ablative therapies for prostate cancer at United States cancer centers: results from a national registry. World J Urol. 2023 May;41(5):1309-1315.
[ii] Calculation of life expectancy was based on the Charlson Comorbidity Index