Different Types Of Focal Therapy
- HIFU : HIFU focuses the energy of sound waves to create heat and destroy cancer cells. Just like a magnifying glass concentrating sun rays to burn a hole in the paper. During the procedure, an ultrasound probe is inserted into the patients rectum while the patient is asleep from anesthesia. Guided by MRI and ultrasound 3D-images, the physician finds the tumor, plus the area to be treated, and delivers the energy aimed at the diseased tissue in the prostate gland. HIFU is a noninvasive precision treatment that spares healthy tissue and lowers the chances of negative side effects associated with radical prostate surgery or radiation, such as impotence, incontinence and bowel function disturbance. UChicago Medicine is the first medical center in the Midwest to offer and perform this procedure with the newest Focal One advanced robotic HIFU technology. This fills a significant treatment void for men with localized prostate cancer who find themselves in between active surveillance and whole gland treatments such as radiation or surgery. The treatment has been used for years in both Europe and Asia.
Urologists Ariel Shalhav, MD, and Scott Eggener, MD, answer questions about new treatment options for prostate cancer, including focal therapy and HIFU, as well as specialized care programs for men diagnosed with advanced prostate cancer or at high risk for the disease.
Featured Patient Testimonial: Toms Story
I just felt like the technology and the skill level of HALO Dx was light years ahead of what was here available to me locally and thats why I made the choice to go down there. It just seems like a rational, logical alternative that you dont have to be a doctor to be able to appreciate.
Other Factors Affecting Prostate Cancer Treatment Cost
Apart from the type of surgery or treatment and the choice of technology, the following are some of the factors that affect the overall prostate cancer treatment cost:
Type of Hospital
There are several hospitals around the world that provide world-class medical treatment to patients. The greater the number and quality of services offered by the hospital, the expensive is the treatment at the hospital.
Therefore, the total cost of prostate cancer treatment that you have to pay actually depends on the level of services that you expect from the hospital. To be able to receive five-star services from the hospital, you must be willing to pay lavishly for it.
Experience of the Surgeon
Expertise and skills of the treating doctor matter a lot when it comes to successful treatment of any cancer type. It takes a lot of patience, courage, and knowledge to treat a cancer patient and this is the reason why the most experienced surgeons tend to charge a greater fee for their services.
However, that does not mean that all the experienced and qualified surgeons charge fees that an average patient cannot afford. There are many highly educated and skilled doctors for prostate cancer treatment that offer their services with an equal compassion at a reasonable rate. Therefore, one must try to find a credible doctor with required credential who charges a fee that a patient can afford.
Length of Stay at the Hospital
Cost of Accommodation, Food, and Local Travel
|Cost per Day|
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Primary Focal Therapy For Localized Prostate Cancer: A Review Of The Literature
Focal therapy for prostate cancer could balance undertreatment and overtreatment of localized prostate cancer for highly selected patients. Long-term oncologic outcomes are not yet available for any modality. Patients should be informed regarding currently available outcomes, the necessity of adherence to a stringent follow-up protocol, and the possible need for additional targeted therapy or future radical treatment in case of recurrence.
Other Treatment Options For Prostate Cancer
There are several other prostate cancer treatment options that are available for the patients. Chemotherapy is one of the other popular treatment modality that may be used after surgery for patients with the cancer of the prostate.
The following table highlights the average cost of chemotherapy for prostate in some of the top medical tourism destinations in the world:
- Hormone therapy
- External beam radiotherapy
Thus, the total cost of prostate cancer treatment varies greatly from one individual to another, depending on the individual medical case.
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Potential Benefits Of Focal Therapy For Patients With Early
- Lower risk for side effects such as urinary incontinence, impotence and compromised bowel function, as compared to surgery or radiation therapy
- Minimally invasive, outpatient procedure
- If necessary, focal therapies can be repeated in the future
- Unlike some prostate cancer treatments, focal therapies do not limit the option to have radiation therapy or surgical treatment at a later time
- Quick recovery it is an outpatient procedure and patients can return to desk work the following day
Our prostate cancer experts describe focal therapy as being similar in concept to a lumpectomy for breast cancer. Rather than removing the entire prostate, focal therapy is a less invasive way to destroy just the cancer while leaving healthy tissue in place. Patients are followed closely after focal therapy. Short-term cancer outcomes are very favorable but longer-term outcomes are largely unknown.
The Nyulmc/sperling Prostate Cancer Center
Between April 2013 and April 2014, 21 men underwent focal laser ablation as part of a collaboration between the NYULMC Smilow Comprehensive Prostate Cancer Center and the Sperling Prostate Cancer Center. All candidates for this collaborative focal laser ablation of the prostate study signed informed consent to participate in a longitudinal outcomes study.
The selection criteria for focal laser ablation included a 10-year life expectancy, between one to two focal abnormalities on mpMRI consistent with prostate cancer, no Gleason pattern 4 disease on random TRUS-guided biopsies of the normal appearing prostate on mpMRI, focal abnormality on MRI < 15 mm, and no Gleason score over 7. In most cases, preservation of potency was a very high priority. Candidates are extensively counseled regarding the very limited short-term and lack of long-term oncologic outcomes data with focal prostate cancer laser ablation.
Fiber placement T2-weighted axial sequence.
Temperature-sensitive fast spoiled gradient-recalled echo images.
Postablation gadolinium-enhanced T1-weighted axial sequence.
To date, there has been no significant change in the mean AUASS, IPSS, or SHIM between 3 to 6 months and baseline . Incontinence has not been reported by any patient in the perioperative or postoperative setting. The mean preoperative PSA value was 5.40 . Among the 12 patients in whom the 6-month PSA was available, the mean PSA value decreased from 5.10 at baseline to 3.69 at 6-month follow-up .
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What Is Mri Focal Laser Ablation
MRI Focal Laser Ablation is a novel, minimally invasive focal prostate cancer treatment that uses MRI guidance to place a laser fiber through the rectum precisely into a targeted prostate cancer tumor. When the laser is activated, the laser energy generates heat that ablates the tumor. The treatment is monitored by magnetic resonance imaging throughout, which ensures that the target tumor is completely encompassed while avoiding harm to nearby structures. There are limited published data on effectiveness.
MRI Focal Laser Ablation is designed to destroy a patients main prostate tumor , while sparing healthy tissue. Its accuracy allows the preservation of normal tissues and structures adjacent to the zone of ablation. This means that urinary and sexual functions are not significantly damaged by the treatment. In other words, the goal is to control prostate cancer while preserving a mans quality of life.
MRI Focal Laser Ablation is an outpatient procedure performed under local anesthesia and sedation. There is no surgery or radiation, and the procedure is complete in about 2 hours. The ablated tumor can be followed up by MRI imaging and MRI guided fusion biopsy at intervals as determined by the physician. If a new tumor occurs, MRI Focal Laser Ablation can be repeated. In addition, it does not rule out any other prostate cancer treatment if needed in the future.
Selecting Candidates For Focal Ablation
There is no consensus how to optimally stratify men with localized prostate cancer to RP, RT, FA, or AS. A consensus statement recommends that all candidates for FA should undergo an MRI, MRFTB, and SB., An alternative would be to perform transperineal saturation biopsy to map the disease. We offer FA to men with a single MRI lesion without gross extracapsular extension who have high-volume GGG 1 or any volume GGG 2-3 and very select cases of GGG 4. Generally, we do not exclude cases with low-volume contralateral GGG 4 .
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What Is The Outlook For Patients Who Receive Focal Therapy
While the use of focal therapy for localized prostate cancer appears to be a promising development in a number of ways, it is still considered investigational and not yet part of standard therapy. There are a number of reasons for this, as follows:
- The criteria for selecting ideal candidates havent been fully agreed on. This is an important question because mistakenly using focal therapy in place of a more traditional treatment could allow a cancer to go under-treated.
- The criteria for defining an index lesion still need to be agreed on.
- The idea that the index lesion determines how the cancer will develop hasnt yet been proven.
- The factors that define treatment success or failure, and the triggers for re-treatment still need to be determined.
- The long-term effectiveness of focal therapy is unknown.
- It isnt clear that all side effects are eliminated by using focal therapy.
- Focal therapy doesnt allow for firsthand pathologic and biologic study of cancerous tissue, as can be done when using surgical treatment.
- Focal therapy sometimes leaves behind untreated cancer, which could possibly raise the risk of more serious problems in the future.
- The overall cost to the healthcare system may be greater for focal therapy than for standard treatments.
The Average Cost Of Prostate Cancer Treatment: Top Countries
Like any other cancer, prostate cancer treatment is delivered with the help of different modalities. Thus, the total treatment package cost differs from one patient to the other. The selection of treatment modalities that are best expected to work in the case of patients further depends on certain factors, including the following:
- Age of the patient
There are several other types of prostate cancer surgeries apart from prostatectomy and TURP. Two of the other types of surgeries include CyberKnife treatment , high intensity focused ultrasound , cryosurgery, and orchiectomy. However, these two forms of surgeries are less common and largely depend on the preference of the surgeon and the condition of the patient.
The exact prostate cancer surgery cost depends on several factors. The following are some of the factors that dictate the overall prostate cancer surgery cost:
- The type of incision and its location
- The type of technology used
- Type of procedure
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How Does Laser Focal Therapy Compare To Other Focal Methods
In comparison to another popular focal treatment methods like high-intensity focused ultrasound , laser focal therapy is not limited to only small glands and has demonstrated much higher levels of accuracy with lower risk of side effects such as, erectile dysfunction.
High intensity focused ultrasound uses ultrasound instead of laser to heat the tissue. To obtain the ablation diameter of the laser used in our approach, HIFU would require > 20 overlapping ablations. What if the patient moves a little and the device misses a spot? When treating cancer, its important to get all of it. The vast majority of HIFU centers use ultrasound guidance , losing the precision of MRI and the important real-time information that MRI thermometry provides in protecting vital structures. Studies show significant urinary and sexual problems after HIFU because important tissues and nerves can be damaged during the procedure.
Laser focal therapy boasts many benefits for patients compared to other treatment methods for prostate cancer. No general anesthesia is required for the therapy, and patients are able to return to work as early as the day after the operation. Additionally, laser focal therapy carries lower risk of side effects compared to other treatment methods such as, impotence, and urinary incontinence. Laser focal therapy also does not rule out the exploration of further treatment options such as surgery or radiation therapy if needed later.
*Results may vary
Phase Ii Clinical Trials
At present, there are fewer than ten sites in the United States that offer FLA. As early phase I trials have demonstrated the safety and feasibility of FLA for prostate cancer, the efficacy of this therapeutic modality is being examined in phase II trials at our institution as well as at the University of Toronto and the National Cancer Institute. Our NCI-funded study investigates the oncologic efficacy of FLA and the MR sequences and imaging findings that predict successful oncologic treatment secondary endpoints include safety and quality-of-life measures like urinary and sexual function. In comparison to our phase I trial , the inclusion criteria have been broadened to include intermediate-risk patients . Additionally, lesions in multiple sites are targeted for ablation following confirmation of anatomic concordance between biopsy and MRI, and follow-up is more rigorous, including biopsy of the ablation zone at 3 months and twelve-core biopsy of the treatment zone at 12 months. The study is active, and recruitment is ongoing.
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Our Workup Treatment And Follow
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Featured Patient Testimonial: Dr David Mantik
As a physician speaking to a patient, I have on a number of occasions disclosed to them that I myself had prostate cancer and actually had this procedure and I highly recommend it for the appropriate candidates.
Dr. David Mantik is a radiation oncologist. For more than 40 years, hes specialized in the use of radiation therapy to treat patients with prostate cancer.
However, at the age of 79 when he noticed his PSA score was rising, Dr. Mantik went to see Dr. John Feller. Now in remission, Dr. Mantik shared why he chose laser focal therapy over radiation treatment for his prostate cancer.
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Advantages Of Laser Focal Therapy
A minimally invasive outpatient procedure
Relatively Rapid Recovery
Tends to have fewer disruptions to daily life compared with traditional treatment
No General Anesthesia
Uses local anesthesia and moderate, conscious sedation
LFT has a lower reported incidence of erectile dysfunction and urinary incontinence than radical prostatectomy and radiation therapy
If necessary, LFT is a repeatable procedure
If necessary, surgery and radiation are options. RP was not complicated by the FLA procedure.
Focal Laser Ablation: The Casit Approach
Focal laser ablation achieves oncologic control by inducing hyperthermic conditions throughout the target lesion. Successful treatment requires accurate guidance of the laser fiber to the target lesion as well as real-time monitoring. Both of these tasks can be achieved with magnetic resonance imaging, however, this method is time consuming and expensive. We are developing an alternative approach in which ultrasound and interstitial probes are used for laser fiber guidance and treatment monitoring respectively .
This project is a multi-disciplinary effort involving urologists, radiologists, pathologists, engineers and industry collaborators. The video below outlines our journey which started with the development of targeted biopsy for prostate cancer diagnosis.
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What Is Focal Therapy For Localized Prostate Cancer
Focal therapy is a treatment for prostate cancer of low to intermediate aggressiveness that is completely contained within the prostate.
For many years there have been two main approaches to managing localized prostate cancer. The first is active surveillance or watchful waiting. In cases of older men or low-risk patients, regular medical tests are conducted to make sure the cancer isnt spreading. No other action is taken because the cancer is stable or growing so slowly it wont cause problems right away. If tests show the cancer is spreading, treatments can begin. Of those men assigned to active surveillance, about one-third will eventually need to have surgery or radiation.
The second approach to treating localized prostate cancer has been the use of radiation or surgery. This is effective for removing any tumors present but is typically associated with side effects in the urinary, sexual, and bowel function. Two common side effects include loss of control over urinary functions and erectile dysfunction
What Treatments Are Used In Focal Therapy For Localized Prostate Cancer
Focal therapy uses ablation, which is the use of extreme temperatures to destroy tissue. In focal ablation, the area of the prostate that contains the index lesion is targeted, rather than treating the entire prostate gland. Focal ablation techniques include:
- Cryotherapy: The use of very cold gases passed through needles to freeze and destroy cancer tissue.
- HIFU : The use of high-frequency sound waves directed at the tumor through an ultrasound probe inserted into the rectum. The high intensity waves cause the diseased tissue to heat up and die.
- : A drug called a photosensitizer is injected into the bloodstream. This drug then absorbs light rays directed at the tumor, and produces an active form of oxygen that destroys cancer cells.
- Laser ablation: The use of laser radiation energy pinpointed to a very small area to burn away cancerous tissue. Some laser ablation has the advantage of being able to be performed at the same time as magnetic resonance imaging , allowing very specific targeting and also real-time views of results.
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