The CaPSURE registry (Cancer of the Prostate Strategic Urologic Research Endeavor) is a remarkable ongoing collection of information about prostate cancer patients drawn from 36 clinical sites that participate in this endeavor. Currently, data on more than 13,000 men exists in CaPSURE. While their identities are protected, information on factors such as date of diagnosis, cancer risk factors, and treatment chosen is available. At any given time, this database can generate a snapshot of what’s going on in the clinical world of prostate cancer.
A journal article entitled “Time Trends and Local Variation in Primary Treatment of Localized Prostate Cancer” came out in March, 2010.[i] The numbers from the registry revealed the following average percentages of treatments chosen:
- Prostatectomy 49.9%
- Beam radiation 11.6%
- Brachytherapy 13.3%
- Cryotherapy 4.0%
- Androgen deprivation monotherapy 14.4%
- Active surveillance 6.8%
Over time, according to the authors, the treatment trends were moving away from overtreatment of low-risk disease. What does this mean?
There is increasing research evidence that Gleason 6 (3+3) prostate cancer does not necessarily behave like cancer—it often appears to not progress to Gleason 7 disease. In fact, new genetic testing that can identify specific genomes and mutations increases confidence that such cancers may not require the kind of radical treatments that come with risks of urinary and sexual damage.
On the other hand, not every patient is comfortable with leaving untreated cancer in his body. This type of patient is not a good candidate for active surveillance. This is where image-guided focal treatment is a game changer. By precisely destroying just the cancerous tumor (and a margin of safety), the risk of urinary and sexual harm is vastly reduced. The most widely used focal treatments, using extreme heat or cold, are minimally invasive and offer rapid recovery times. Our own approach, focal laser ablation, is guided by real-time multiparametric MRI and is performed under a local nerve block. Patients are right back on their feet after the procedure, and there is no catheter.
It’s our belief that when we look prostate cancer treatment trends in the near future, we will see diminished percentages in whole gland treatments and an increased proportion of focal treatments. We believe that focal laser ablation is a “rising star” on that stage, and are proud to be the leading experts in this growing treatment wave.