Thursday 11 November 2004

New way to beat prostate cancer
By David Derbyshire

A revolutionary technique using powerful sound waves to melt away
prostate cancer without distressing side effects is about to start
trials in Britain, offering hope to the 30,000 men diagnosed with the
disease each year.
Doctors believe the treatment, which uses high intensity focused
ultrasound (Hifu), is as effective as conventional surgery or
radiotherapy, but with far less risk of impotence and incontinence.
 
Surgeon Mark Emberton with the ultrasound probe
It is also cheaper, less invasive and can be finished in less than three
hours under a local or regional anaesthetic.
The trial involving 150 men, which is due to start in January, follows
promising results from international studies.
A Japanese survey of 132 men treated with ultrasound for early and
medium stage prostate cancer found that almost 70 per cent were free
from disease after five years. Only 22 per cent complained of problems
with sexual function.

Conventional surgery and radiotherapy have similar survival rates - but
can leave more than two thirds of men impotent.
If the trial is a success it could pave the way for the first national
prostate cancer screening.

Many doctors object to screening because the side effects of any
subsequent treatment are so unpleasant.
Prostate cancer is the most common cancer among British men. Although
the disease is very treatable if caught early enough, most men discover
they have it only when it is in its later stages. About 10,000 die every
year.

Mark Emberton, a consultant urologist at the Royal Free and University
College London School of Medicine, who is leading the trial, said: "Men
with early prostate cancer are faced with a difficult choice about
treatments. A lot of men with low-risk cancer are just actively
monitored.
"In many people, it's a slow-growing disease. But in men who are young
or who have an aggressive form of the disease, there is an obvious need
to contemplate treatment.

"The benefit of Hifu is that it is non-invasive - there are no cuts and
no radiation. It can also be done as a day-case procedure."

The person administering the treatment will not even have to be a
trained surgeon, who needs 15 years of experience before embarking on
conventional surgery for cancer of the prostate.

Mr Emberton said that, potentially, a skilled nurse could learn the
procedure in months.

Hifu uses high energy ultrasound generated from a probe inserted in the
rectum under a local anaesthetic.
The sound waves are focused on sections of the prostate which heat up to
90C in a second - destroying tissue almost instantly.

Using a computer screen, the surgeon guides the ultrasound beam away
from nerves essential for erections and for bladder and bowel control.
Ultrasound can be used only to treat single tumours or large parts of a
tumour. It cannot treat advanced cancers which have spread to different
parts of the body.
The sound waves cannot pass through bone or air, restricting the types
of cancers that can be treated.

The trial, which will involve hospitals in London and Oxford, will
include men with early and medium stage prostate cancer, where the
disease has not spread. They will be followed up for five years.
Nick Stevens, the managing director of UKHIFU, the company co-sponsoring
the trial, said 6,000 patients around the world had been treated.
"It's pain-free, unlike most surgery. It's convenient, you don't stay in
hospital, and there's no need for a blood transfusion," he said.

"We expect from past studies, including the five-year study in Japan,
that around 80 per cent of men would retain erectile function. We hope
for around 85 to 90 per cent efficacy - possibly even higher.".
A conference in London next week organised by the Prostate Cancer
Charity will discuss the new technique and other approaches such as
cryotherapy, which kills tumours with frozen gas.
John Neate, the PCC chief executive, will call for change in the way the
cancer is tackled, including specialist teams to manage the care of men
from diagnosis to treatment.

Dr Chris Hiley, a spokesman for the charity, welcomed the trial, but
said it was too early to talk of "revolutionary treatments".

The Government is also expected to announce more details of its strategy
for tackling the disease.
Factfile

The prostate is a golfball-sized gland in the pelvis and one function is
to produce prostatic fluid, one of the five main types of fluid in
semen.

Almost all prostate cancers occur in men over 50. Although treatable if
caught early, half of men diagnosed have their cancer discovered at the
late stage.
Symptoms include a frequent need to urinate, especially at night;
problems urinating; genital pain; lower back pain; blood in urine; pain
in the hips or pelvis; and difficulty in achieving or keeping an
erection.

If doctors believe that the cancer is slow-growing and has not spread
outside the prostate, they may actively monitor the disease rather than
treat it. Men can live with the disease, symptom-free, for decades.

If the disease is diagnosed in a younger man or if it is aggressive,
surgery or radiotherapy are used to kill the cancerous cells.

For men under 70, surgery is usually the preferred option. The most
common kind is a radical prostatectomy in which the whole gland is
removed.
Around 70 per cent have no signs of cancer 10 years after surgery but a
similar number suffer from impotence after treatment.

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."