In Treating Prostate Cancer, Researchers Seeking Less Invasive Method

Cancer treatments are not a one-size-fits-all fix – each type of cancer requires different considerations.

Early in 2020, a Food and Drug Administration advisory committee reviewed a new treatment for prostate cancer called focal therapy, which targets tumors with lasers to either burn or freeze the cells. It’s a less-invasive option than surgery or radiation. But an FDA committee denied it market approval.

In a session with National Press Foundation fellows, Dr. Behfar Ehdaie, urological surgeon at Memorial Sloan Kettering Cancer Center, said convincing officials and the public to rethink cancer data and treatment methods is a common battle for oncologists. For example, in the last 20 years, oncologists rarely used MRIs to detect a tumor’s location and stage. Now, Memorial Sloan Kettering doctors use it regularly for prostate cancer check-ins; they’ve found it to be accurate 70% of the time for patients diagnosed with more-aggressive prostate cancer.

Oncologists also used to suggest prostatectomy or radiation upon diagnosis – even for cases where the cancer was less aggressive and at lower risk for metastasizing. But in recent decades, Ehdaie said doctors have found that actively monitoring lower-risk cases results in the same mortality rate as treating patients with surgery or radiation.

Ehdaie said focal therapy can be another way to delay radical treatments. Since lumpectomies are not available for prostate cancer patients as they are for other kinds of cancer patients – such as those with breast cancer – the only way to get rid of tumors is with radiation or surgery. Both can cause a loss of sexual function and increased urinary incontinence. Focal therapy removes the tumor itself and leaves the healthy parts of the prostate, thus saving some of its functions.

The issue with prostate cancer is that in 96% of cases, it is multi-focal. That means there are multiple tumors spread throughout the prostate. “It’s like a chocolate chip cookie,” Ehdaie said.

That complicates things, since oncologists can’t zap all infected areas and be confident a functioning prostate will remain. Another issue Ehdaie mentioned is that there isn’t enough research on the long-term effects of focal therapy.

Although the FDA didn’t give market approval for focal therapy, it is available in Europe, and patients aware of it may seek it out there. For now, Ehdaie is working on an approved treatment that combines active monitoring with focal therapy to treat prostate cancer.

This program is funded by the American Association for Cancer Research. NPF is solely responsible for the content.

Dr. Behfar Ehdaie
Urologic surgeon, Memorial Sloan Kettering Cancer Center
Cancer Resources
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