"The results of our study are very encouraging. We hope that men diagnosed with prostate cancer may soon be able to undergo a day-surgery procedure to treat their condition with very few side effects. That could mean a significant improvement in their quality of life."
Dr. Hashim Ahmed, The Lancet, April 17
WHAT follows is mostly good news; and because any woman with special men in her life has a vested interest in how treatments for prostate cancer evolve, the stories are as relevant to women as to men.
At some point in our lives, up close and personal or on video, most of us have seen a guy doubled over in excruciating pain after he's been hit in the groin with a badly aimed object. We can only imagine how that man would feel if such obvious discomfort were to last for months on end.
Yet that may occur if the nerves that wrap around the walnut-sized prostate gland are unavoidably compromised during the intricate surgery that, traditionally, has been the treatment of choice for an advancing cancer.
Add to that the embarrassment of temporary or ongoing incontinence, or the loss of self-esteem related to a diminished sexual prowess and you have a recipe for post-surgical depression serious enough to warrant counselling.
No surprise then that the results of a 2007-2010 of a nerve-sparing treatment by Dr. Hashim Ahmed and his colleagues at London's University College Hospital are being called encouraging - particularly when they are echoed by Drs. Matvey Tsivian, Michael Abern and Thomas Polascik in their own Lancet article, Prostate Cancer Treatment Unblinded.
Polascik is director of a Focal Therapy Program in North Carolina which uses magnetic resonance imaging (MRI) to guide the treatment in its work at Duke University Medical Centre, North Carolina.
In brief, the Ahmed team treated 42 men aged 45-80 who had one or more zones of cancer in their prostate glands with "high-intensity, focused ultrasound" which was "delivered to all known cancer lesions and to a margin of normal tissue."
Reached for his comment, Tsivian said, "The very premise of focal therapy as an approach to the treatment of localized prostate cancer is that of sparing damage to uninvolved tissues . . . to limit side effects on one hand and better preserve quality of life on the other."
Stressing the need for "standardization of focal therapy" and "patient selection" while adhering to approved treatment criteria so as not to compromise control of the cancer, Tsivian noted that earlier reports have shown that "focal treatment may maintain (sexual function) in 85-90 per cent of men who were potent pre-intervention.
"Furthermore, the sideeffects profile appears most favourable compared to that of radical prostatectomy or radiation therapy.
"To the best of my knowledge," Tsivian concluded, "there has been no report yet of a case of persistent urinary incontinence following focal therapy."
In lay terms, Ahmed's results showed that not only was pain less debilitating, but that the duration and severity of side effects like incontinence and impotence were considerably reduced.
Most important of all was that the Ahmed study reported "after re-treatment of four patients, 39 of the 41 men who remained in the study had no evidence of disease on examination at 12 months."
So: out of hospital the same day, less pain and a better chance of preserving those vital nerves; I told you women would be interested.
The best news of all is that if the results described by Ahmed and Tsivian prove to be consistent, we can hope that less invasive treatments for prostate cancer will be added to physicians' basket of tools within about five years.
But five years with unknown hurdles along the way is a long time to wait.
Current medical knowledge suggests that, if they live long enough, most men will show some evidence of the disease. So the best approach is for men between 40 and 45 to ask for a prostate-specific antigen (PSA) blood test - even if it does cost $35.
Why is that, Minister De Jong? Regular mammograms are free, in part to save acute care costs; so how about some gender equality here!
Results of that simple test can then be used as a benchmark against which the readings of regular follow-up tests can be compared.
Yet, to varying degrees, the risk of being faced with invasive procedures or with long-lasting side effects after surgery has kept men from asking their doctors to perform even the baseline test for this third leading cause of cancer deaths in males.
Call it what you will, that approach to managing their health care is liable to backfire if a man has a family history of prostate cancer, or if the type of prostate cancer he already has is an aggressive, fastgrowing malignancy.
The longer the cancer goes without being addressed, the fewer the treatment options available and the more uncomfortable the side effects will be - especially if the cancer escapes the perimeters of the gland.
So for now, the best advice is to do as the doctor says: have the PSA test early and have it regularly.
If a cancerous area is identified, do the research about treatment options. Ask the questions and get a second opinion if you're still unsure about the best course of action.
Good places to start: www.prostatecancerbc.ca and www. prostatecentre.com.
The North Shore Prostate Support & Awareness Group can be reached by phone at 604-929-5183.
