A New Paradigm
For Prostate Cancer Treatment
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Most physicians have a long-standing conviction that patients diagnosed with prostate cancer must have their entire gland either surgically removed or radiated. This conviction stems from the belief that all prostate cancer is "multifocal." That means if a malignant tumor is found in one location (or only on one side of the prostate) it's likely that tumor cells exist throughout the entire gland. For most physicians this belief holds true even if only a small tumor is found during a patient's prostate biopsy.
While this conviction was good medicine before the introduction of the PSA blood test (prostate specific antigen) - it may not be as relevant for all men today. The fact is that PSA screening has changed everything. PSA has created a new paradigm for prostate cancer by changing the point in time that we find prostate cancer (Grossfeld 2001). While researchers continue to look for more accurate serum markers, PSA testing has undoubtedly saved thousands of live through early detection.Today, we can diagnose prostate cancer much earlier and often in a single location or only on one side of the prostate.
In cases where multiple tumors are found they often turn out to be of a size and low risk level that might not necessarily threaten a patient's life (Harvard Medical School 2011). Although some prostate maligancies are "multifocal" and some tumors are very dangerous, the question arises whether treating the entire prostate gland is necessary for every man. If we establish, with a high degree of confidence thanks to advanced diagnostic technologies, that a patient is a candidate for a focal treatment, it is possible to develop a treatment tailored to that person's disease.
In my current practice I specialize in approaching prostate tumors in a way that determines if a patient is a candidate for whole gland treatment, or a candidate for targeted (or focal) treatment. The goal of a targeted treatment is to destroy only a patient's known tumor while sparing the remaining healthy tissue and avoiding collateral damage to sensitive structures that can affect a man's quality of life.
The idea of a targeted treatment is not new. Today, breast surgeons have options besides removing the entire breast to treat breast tumors. Instead, for qualified patients a lumpectomy is used to remove only the know tumors. What's ironic is that the idea of a similar "targeted treatment" for prostate tumors has lagged behind the breast lumpectomy by almost 30 years. -
The Science Behind Targeted Prostate Treatment
The science that supports targeted treatment is based on pathology studies from prostate glands that were surgically removed then examined to identify the location, volume, and the aggressiveness of any prostate cancer discovered. Multiple published studies clearly show that up to one third of all prostate tumors appear to be "unifocal" rather than "multifocal," meaning they are found only on one side of the gland (Harvard Medical School 2011). As a result up to 70,000 men a year might clinically qualify for a targeted prostate treatment. Likewise, based on the degree of clinical significance, the actual number of potential candidates for targeted treatment may be even higher. Studies suggest that up to 30% of multi-focal tumors may be clinically insignificant, meaning that based on the volume and aggressiveness of the disease found, some patients might not need immediate or entire gland treatment.
This illustration shows a unifocal tumor located in only one location.
