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University of Chicago study seeks safer treatment for prostate cancer

Updated: April 12, 2013 6:12AM

Men with low-risk prostate cancer have long had to choose between aggressive treatment that had the potential for significant side effects or active surveillance, with the risk of the disease getting worse.

A small, early-stage trial at the University of Chicago could one day offer another option.

The “phase I” trial found that focal therapy — described as the “male version of a lumpectomy for breast cancer” — appeared to be effective in burning away only the cancerous cells in the prostate, according to a report in the journal Radiology.

Six months after surgery, seven of the nine men in the trial who had low-risk prostate cancer and one who had intermediate-risk cancer no longer had evidence of cancerous tissue in biopsies of the treated area, the study showed.

None of the nine men had a major complication or serious side effect six months after surgery, though potential risks include rectal-wall damage, bleeding and infection.

“This experimental approach appears to combine the most attractive element of treatment, eradication of the cancer, with the most appealing element of active surveillance, maintaining quality of life,” said lead researcher Dr. Aytekin Oto, a radiology professor and chief of abdominal imaging for University of Chicago Medicine.

Aggressive treatment typically involves surgery or radiation therapy to rid all traces of cancer in the prostate. These early results are substantially worse than with surgery or radiotherapy, where five- to 10-year cancer-free success rates are around 90 percent after treatment for localized disease.

But Oto said it’s far too early to know whether it will turn out to be the “middle ground” he hopes it will be for men with low-risk prostate cancer.

“We definitely need longer-term data,” he said.

Dr. Michael McGuire, chief of urology for NorthShore University HealthSystem and co-director of its John and Carol Walter Center for Urological Health, called the findings “interesting and exciting,” saying they could pave the way to eventually being able to target only cancerous cells.

But McGuire noted, “Most series of prostate cancer don’t find cancer in just one focal area. That’s why we don’t do a lumpectomy equivalent in there.” So he said it’s likely that only a certain group would benefit.

Dr. William J. Catalona, director of the clinical prostate cancer program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, is even more cautious. Catalona called the early results from the U. of C. study “worse than with surgery or radiotherapy” in terms of cancer-free success and said he also worries that focal therapy could scar the area around the prostate and “make it more difficult or impossible to perform a clean nerve-sparing radical prostatectomy when it finally became apparent that focal therapy was inadequate.”

Dr. Scott Eggener, a U. of C. Medicine associate professor of surgery who was involved in the research, takes issue with that. Eggener said focal therapy wouldn’t prevent more aggressive surgery down the road.

A phase II trial is under way. Doctors are seeking 27 men to be involved who have a “Gleason” score of seven or less.

In the phase I trial, a thin, flexible laser fiber was placed directly into the tumor, and MRI scans were used to precisely guide the delivery of laser energy to the tumor. The laser superheats and destroys small prostate tumors.

The trial was supported by a research grant from the Partnership for Cures Foundation and by Visualase Inc., which makes the laser ablation tools used in the study. Oto and Eggener said they have no ties to Visualase.

Focal laser ablation is the latest in a series of attempts to target cancerous cells while preserving healthy cells. Others that are being tested include high-intensity focused ultrasound and cryotherapy.

Oto said one advantage of focal therapy is that surgeons can use an MRI to visualize the surgery as it is happening.

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