Enigma of Prostate Cancer Management

Because of the negative effects that most prostate cancer therapies have on quality of life that patients experience through radical prostatectomy, radiation, hormone therapy, and cryosurgery, a treatment option titled Active Surveillance has been developed. Patients being managed with Active Surveillance are deemed to have a cancer that may not be lethal or carry a high degree of morbidity.

Using Active Surveillance patients under go frequent PSA examination and folllow-up biopsies on a periodic basis. 80% of patients who are managed with Active Surveillance are ultimately deemed at risk for either serious morbidity or mortality and are committed to a treatment arm i.e. radiation therapy, cryotherapy, or radical prostatectomy. Therefore the process of Active Surveillance mandates that patients will be treated with a higher grade and stage of cancer than when they were initially diagnosed thereby increasing the risk of failure of therapy. The quality of life issues that are at risk include urinary incontinence and impotence or erectile/sexual dysfunction.

HIFU eliminates the need for Active Surveillance because of its minimal effect on quality of life issues. It can be performed and the cancer can be eradicated while preserving continence and sexual function. Therefore the threat of impending cancer progression can be eliminated in a way that prevents the potential for serious morbidity.