A new non-surgical prostate cancer treatment offered at the
University of Texas Medical Branch virtually eliminates the side effects
of impotence and incontinence that can occur when patients receive the
traditional treatment for prostate cancer - surgical prostate removal.
UTMB’s Chairman of Radiology, Dr. Eric Walser, is
one of only a few physicians in the world and the only physician in
Texas who performs this groundbreaking procedure. Using a
state-of-the-art, MRI-guided laser ablation instrument developed at
UTMB, he zaps away the cancer without removing the prostate.
With national standards for prostate cancer
screening changing so dramatically over the past year, many men are
confused about what it means to have prostate cancer, whether they
should be tested for it and what they should do if they test positive.
The American Urological Association released
new prostate cancer screening guidelines saying men under 55 should no
longer receive routine prostate screening and that men over 80 should
not receive it if they have a life expectancy less than 10 to 15 years.
The association determined the odds of preventing prostate cancer death
with a PSA (prostate specific antigen) blood test for men ages 55 to
69 amounted to one life spared for every 1,000 men screened over a
This is on the heels of the U.S. Preventive
Services Task Force’s statement last May, saying that much more harm
than good was being done to men who underwent screening, biopsy and
surgical removal of their prostate gland. The vast majority of prostate
cancers are so slow-growing that they will never cause a problem. On
the other hand, the impotence and incontinence that can result when the
sensitive nerves surrounding the prostate are damaged or severed
during surgery can be devastating.
The gist of all this is that the standard
treatment - surgical prostate removal - causes more damage than the
disease ever would have.
"The problem is, most men who test positive,
even if the risk is one in 1,000 of dying of prostate cancer," said
Walser, "still just want to get it out of there. You never know if you
are going to be that one."
In the past, there was no way for doctors to
remove prostate cancer without removing the whole prostate gland. This
is because the available imaging technology was not powerful enough to
illuminate the cancer and the available laser ablation technology was
not focused enough to remove the cancer without damaging surrounding
tissue. But in recent years, the technology has improved significantly.
"Our approach pairs the most advanced MRI
imaging to identify cancer-suspicious areas in the prostate and the
most advanced laser technology to remove it completely, with virtually
no risk of impotence or incontinence," said Walser.
Walser, who has been performing this procedure
for three years, says this new way of treating prostate cancer offers
selected men much more peace of mind than active surveillance or "watchful waiting", the traditional alternative to radical treatment.
Active surveillance is an invasive method to follow these patients and
involves blood draws and often multiple prostate biopsies repeated
yearly. "Watchful waiting" is less invasive but requires monitoring of
patient symptoms and repeated transrectal clinical exams. Neither
method actually treats cancer in the prostate. Additionally, prostate
MRI images may be able to separate aggressive from very slow growing
prostate cancers and help physicians identify men needing earlier
NIH-funded clinical trials of this new
procedure so far show that it is safe and effective, with results from
several trials just published online in the journal Radiology and an
ongoing study being conducted at the University of Chicago Medical
For those patients whose prostate cancer is
large, aggressive or has spread outside of the pelvis, ablation therapy
may not be able to fully eliminate it. In those cases, UTMB’s
Department of Urology offers the patient a wide range of minimally
invasive surgical options, including a highly advanced
robotically-assisted laparoscopic option for prostate removal. UTMB’s
radiation oncology department also has methods to treat prostate cancer
with focused radiation therapy.