COMMENTS ON THIS ARTICLE BY GEORGE M. SUAREZ, M.D.

This is another important article in the fast gaining popularity of HIFU as a treatment option for localized prostate cancer. The fact is that as a slow growing cancer, it seems to respond to almost any type of treatment when it is diagnosed early and has favorable PSA and Gleason score. However, Radiation has additional toxic side effects that are not often discussed with the patients. Yet, it remains the most common form of treatment for prostate cancer. These include erectile dysfunction and urinary incontinence and high degree of irritable or "bother symptoms. (bladder and bowel)" What is seldom mentioned is the increased risk of developing a secondary malignancy. Particularly bladder and rectal cancer, reported as high as 70 % greater than men treated with alternatives other than radiation. (1) Furthermore, a recent study from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database has revealed that PSA recurrence after radiotherapy occurred in 63 % of men with 93 % being treated with Androgen deprivation therapy for salvage of PSA failure. (2) These outcomes also add to the ability to treat radiation failures with Salvage HIFU and saving patients from being placed on hormone therapy.


References:

(1) Baxter NN, Tepper JE, Durham SB. et al, Increased risk of rectal cancer after radiation: a population-based study. Gastroenterology, 2005;128:819-824.

(2) Agarwal PK, Sadestsky N, Konety BR et al: and the CaPSURE group. Treatment failure after primary and salvage therapy for prostate cancer: Likelihood, patterns of care, and outcomes. Cancer 2008;112:307-14.