From Urology Times Nov. 2008

Dr. Thomas Walsh working with Dr. Paul Turek and others at UCSF note very preliminary data showing a 1.8 fold risk of Prostate Cancer in men with infertility, and a 1.5 fold risk of developing other cancers.

From the Nov. 2008 Urology Times:

Univ. Calif. Davis researchers report patients treated with radiation for initial therapy for prostate cancer, and men treated with radiation for positive margins at radical prostatectomy have a 2-fold risk for developing subsequent bladder or colorectal cancers due to the radiation exposure.

Caution was urged as there are trends towards treating the positive margins before any rise in PSA confirms residual cancer.

Additionally, at the 2009 American Urology Assn meeting, stats were quoted describing a risk of 1% per year of developing a secondary cancer in the bladder or rectum due to radiation exposure.

From the 2008 PCRI Conference:

The Univ. Calif. San Francisco criteria for active surveillance are:

PSA less than 10
Gleason Sum 6 or less
No grade 4 or 5 tumor on biopsies
Less than 33% cores positive, and no core with over 50% involvement with cancer
Stage T1 or T2

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Treatment is recommended for “Progression” defined as:

Rise in PSA of more than 0.75 ng/dl per year
Lowering of PSA doubling time
Rise in Gleason score on followup biopsies
Increase in tumor size on ultrasound

HIFU Results & Clinical Data

The following is a list of publications and presentations that highlight clinical results and research activity of High Intensity Focused Ultrasound - HIFU.

Visually directed high-intensity focused ultrasound for organ-confined prostate cancer: a proposed standard for the conduct of therapy. Rowland O. Illing*†, Tom A. Leslie‡, James E. Kennedy‡, John G. Calleary*, Christopher W. Ogden§ and Mark Emberton*† *The Institute of Urology and Nephrology, University College London, London, †The Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, ‡Department of Urology, The Churchill Hospital, Oxford, and §Department of Urology, Chelsea and Westminster Hospital, London, UK Accepted for publication in British Journal of Urology 27 July 2006.

Five Year Experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized Prostate cancer. Toyoaki Uchida, Hiroshi ohkusa, Hideyuki Yamashita, Sunao Shojl, Yochihiro Nagata, Toru Hyodo and Takefumi Satoh. International Journal of Urology, Vol. 13, 228-233. 2006.

Outcome Analysis of High Intensity Focused Ultrasound for clinically localized prostate cancer in Japan- Seven-Year Follow-Up. Makoto Suzuki, M.D., Toyoaki Uchida, M.D., Toshiro Terachi, M.D..: Tokyo, Japan. (Presentation made by Dr. Suzuki at Western Sectional AUA Meeting in Maui, June 2006) Visually Directed HIFU for Prostate Cancer –a new standard. Rowland O. Illing**, Sam Dawkins*, Chris W. Ogden* and Mark Emberton**. *Institute of Urology and Nephrology, University College Hospital, London, UK ** The Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK

Treatment of localized prostate cancer using high-intensity focused ultrasound. Toyoaki Uchida. Dept. of Urology University of Tokai Hachioji Hospital. British Journal of Urology International 2006.

Prostate Cancer Therapy with High-Intensity Focused Ultrasound -Comprehensive Review Thomas A. Gardner and Michael A Koch, Indiana University Medical Center, Indianapolis. Clinical Genitourinary Cancer Vol 4. No.3, 2005.

Transrectal High-Intensity Focused Ultrasound in the treatment of Localized Prostate Cancer: A Multicenter Study. Acta Urol. Jpn. 51 651-658, 2005. Toyoaki Uchida. The Dept. of Urology, Tokai University Hachioji Hospital.

High Intensity Focused Ultrasound for the Treatment of Localized Prostate Cancer. A Multi-Center Experience. George M Suarez*, Miami, FL; Rafael Estrella, Santiago De los Caballeros, Dominican Republic; Carlos Garcia, Puerto Vallarta, Mexico. Abstract from Presentation given at The 15th International Prostate Cancer Conference in Vail, Colorado, February 2005

Transrectal HIFU: The Next Generation? Prostate Cancer Research Institute (PCRI) Insights. Douglas O. Chinn, MD Chinn & Chinn Urology Medical Associates, Arcadia, CA February 2005. Pages 8-15.

Clinical Outcome of HIFU for the Treatment of localized prostate cancer: 5-year Experience. Toyoaki Uchida, Hiroshi Ohkusa, Hideyuki Yamashita, Yoshihiro Nagata Department of Urology, Tokai University Hachioji Hospital. Abstract - ISTU 2004

Clinical Outcome of HIFU for Localized Prostate Cancer: 5 year Observations. Toyoaki Uchida, E. Yamashita, Y. Okusa, T. Nagata, Tokai University, Tokyo, Japan. Podium presentation given at the 2004 Japan Endourology and ESWL Conference, Okayama, Japan November, 2004.

High Intensity Focused Ultrasound for Prostate Cancer: Clinical Results and Technological Evolution John C. Rewcastle, Ph.D. Department of Radiology, University of Calgary Alberta, Canada Quality of Life in Patients with High Intensity Focused Ultrasound (HIFU) for localized Prostate Cancer. Toyoaki Uchida, E. Yamashita, Y. Okusa, T. Nagata, Tokai University, Tokyo, Japan. Podium presentation given at the 2004 Japan Endourology and ESWL Conference, Okayama, Japan November, 2004.

Transrectal High-Intensity Focused Ultrasound for treatment of patients with Stage Tib-2N0M0 localized Prostate Cancer: A Preliminary Report. Presentation of preliminary clinical results of transrectal HIFU in stage T1b-2N0M0 prostate cancer. Dr. T Uchida, M.D.

Localized Prostate Cancer Treatment by High Intensity Focused Ultrasound (HIFU) Toyoaki Uchida M.D., Department of Urology, Kitasato University, Tokyo, Japan. The Journal of Highly Advanced Medical Technology. Highly Advanced Medical Technology Research Center, Volume 15, March 2000 (Translated from Japanese and updated with current information by Focus Surgery, Inc.)

Localized Prostate Cancer Treatment by High Intensity Focused Ultrasound (HIFU): Preliminary Results. Toyoaki Uchida M.D., Department of Urology, Kitasato University, Tokyo, Japan. This summary has been abstracted from previously published work and supplemented by additional new treatment data prepared by Dr. T. Uchida, M.D. by Focus Surgery, Inc.

Noninvasive Surgery of Prostate Tissue by High Intensity Focused Ultrasound: An Updated Report. European Journal of Ultrasound. N. T. Sanghvi 2,*, R. S. Foster1, R. Bihrle1, R. Casey3, T. Uchida4, M. H. Phillips2, J. Syrus2, and A. V. Zaitsev2 , K. W. Marich2 , F. J. Fry

The National Cancer Institute (NCI) has stopped a study exploring the possibility that Vitamin E and/or Selenium might prevent prostate cancer.

Last year the recommendations were modified to limit Vitamin E to 200 IU per day to prevent increased risks of strokes and heart attacks, and to preferably stop it altogether. Selenium had been recommended to no more than 100 mcg per day (rather than 200) due to the worry that prostate cancers might actually grow faster if present. Same for Zinc above 70 mg per day.

The current multi-institutional study seems to reflect not only a failure of Vitamin E and Selenium to prevent prostate cancer, but a distinctly possible increased risk in men with family histories of prostate cancer. In addition, Selenium may cause diabetes.

Stick with lycopenes (tomato products), anti-inflammatory medicines, pomegranate juice, and soy proteins.

Erectile dysfunction following Brachytherapy (radioactive seeds implanted into prostate) is commonly quoted to cause ED in 20-25% of men within 2 years after treatment. However, Dr. John Mulcahy, leading ED authority, reports in Urology Times of a French study presented at this year’s American Urology Association. As many as 71% of patients followed for 4 years experienced some form of ED.

Again from Memorial Sloan Kettering Cancer Center, as reported in the Urology Times newspaper, androgen ablation was reported at the American Urology Association meeting this year to impair concentration, spatial ability, multitasking and other cognitive capacities. The researchers suggest patients be advised of this effect, and further study, including brain imaging, be pursued. The study was published in the July 28 online edition of the journal Cancer.

Earlier this year an increased risk of cardiovascular events was associated with Hormone Therapy.

From Duke University as presented at the American Urology Association meeting this year, and reported in Renal and Urology News:

Dr. Lionel L Banez’ group found that for every 1 mg/dl rise in total cholesterol or LDL cholesterol, the risk for recurrence after radical prostatectomy rose 1%. Men with total cholesterol levels of >217 had a 2.5 times higher risk for biochemical recurrence (PSA) than men with cholesterol <167. Statins may be investigated as possible agents in the treatment of prostate cancer.

The Memorial Sloan Kettering (MSK) Cancer Medical Center is one of the top 3 cancer hospitals in the country. A review of their radical prostatectomy results sought to determine how often they achieved the optimal results of: 1. cancer cure (per PSA)
2. full continence
3. no erectile dysfunction (need Viagra or equivalent only)

This “Trifecta” happened at: 1 year—30%
2 years–42%
3 years–47%
4 years–53%

These are the numbers for T1C and T2A cancers.

Aranchuk, et al., J Clin Onc, 23:18, 4146-51.

Be careful when getting overly optimistic quotes from local surgeons regarding their results.