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'Male Lumpectomy' for Prostate Cancer
March 10, 2009 -- "Male lumpectomy" -- cryotherapy that freezes tumors but leaves the rest of the prostate intact -- may be the best treatment choice for many men with early prostate cancer.
The suggestion comes in a presentation to this week's meeting of the Society of Interventional Radiology by Gary M. Onik, MD, director of the Center for Safer Prostate Cancer Therapy and professor of radiology at the University of Central Florida, Orlando.
It's not exactly a new technique. Onik has been exploring its use for more than a decade in men whose prostate cancer has not spread beyond the prostate gland. Now he's collected data on 120 men with prostate cancer who underwent the procedure up to 12 years earlier.
"We've reached a tipping point," Onik says in a news release. "Treating only the tumor instead of the whole prostate gland is a major and profound departure from the current thinking about prostate cancer."
In this way, the technique is similar to lumpectomy for breast cancer. Doctors at first scoffed at the idea that anything short of total mastectomy would be an appropriate cancer treatment. But with careful patient selection and better tumor mapping, lumpectomy has become the treatment of choice for many women with breast cancer.
"I think it is time for men to consider this," Peter Nieh, MD, director of Emory University's Uro-Oncology Center. Nieh reviewed the Onik study for WebMD but was not involved in the study.
Nieh says the idea of leaving prostate tissue behind is so different from standard treatment that it seems "crazy" at first. But it makes sense, he says, when one considers that there are very few cancers in which the entire organ is removed.
"The technique is still not mainstream. You'll hear the criticism that it's not appropriate for all patients," Nieh says. "But when you see how many patients get radical prostate surgery, and multiply that by the 40% who would never die of prostate cancer, that is a lot of patients getting over-treated for what they have."
Onik's data are compelling. Of the 120 patients, 93% are cancer-free an average of 3.6 years after treatment.
The most feared side effects of radical prostatectomy and radiation therapy are incontinence and sexual dysfunction. In Onik's study, none of the men became incontinent and 85% of patients remained sexually potent.
Yet, Nieh says, long-term data on focal cryotherapy remains skimpy. That's reflected in the American Urological Association's 2008 "Best Practice Policy Statement" on cryotherapy.
"This procedure may fill a void in the therapeutic options available to men. ... However, current data are insufficient to determine the incidence or consequence of treatment failure," the statement notes.
One advantage to cryotherapy is that if prostate cancer returns, the procedure can be repeated. That's usually not an option after surgery or radiation therapy.
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Indication
Uroxatral® (alfuzosin HCl 10 mg extended-release tablets) is an alpha1-blocker for the treatment of the signs and symptoms of BPH.
Important Safety Information
Do not take UROXATRAL if you have liver problems or if you are taking antifungal drugs like ketoconazole or itraconazole, or HIV drugs like ritonavir.
UROXATRAL can cause a sudden drop in blood pressure, especially when starting treatment. This may lead to fainting, dizziness, and lightheadedness. Do not drive, operate machinery, or do any dangerous activity until you know how UROXATRAL will affect you. This is especially important if you already have a problem with low blood pressure or take medicines to treat high blood pressure. There may be an increased risk of low blood pressure and fainting when taking UROXATRAL in combination with blood pressure medication or nitrates, or erectile dysfunction medication.
If considering cataract surgery (clouding of the eyes), tell your eye surgeon that you are currently taking UROXATRAL or have previously been treated with an alpha-blocker.
Before taking UROXATRAL, tell your doctor if you have kidney problems.
Also, tell your doctor if you or any family member(s) have or take medications for a rare heart condition known as congenital prolongation of the QT interval.
BPH and prostate cancer can cause the same symptoms. However, UROXATRAL is not a treatment for prostate cancer.
The most common side effects with UROXATRAL are dizziness, upper respiratory tract infection, headache, and tiredness.
Please see UROXATRAL full prescribing information.
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