November 30, 2004
New techniques have added effectiveness
to treatment for prostate cancer
According to the American Cancer Society, prostate cancer is the second leading cause of cancer deaths among men. It is estimated that about 28,900 men died in 2003 from the disease.
NICK KRUG/THE CAPITAL-JOURNAL
Dr. Mark Brandsted, a urologist with Urology Associates of Topeka, is treating prostate cancer with cryoablation. The technique, which has gained in popularity and effectiveness, involves inserting several needles into the prostate by way of ultrasonic guideance and freezing it with argon gas.
By Morgan Chilson
SPECIAL TO THE CAPITAL-JOURNAL
Modifications and technological changes have caused a decades- old procedure to regain popularity in treating prostate cancer.
Dr. Mark Brandsted, a urologist with Urology Associates of Topeka, initially began using cryoablation, which involves freezing cancer cells, on patients who had recurrent prostate cancer after being treated with radiation.
"All cancer treatments for the prostate have their shortcomings, as far as being able to cure the cancer," he said. "With radiation, in particular, the high-grade cancer has been difficult to completely eradicate."
But upon learning about improvements in cryoablation, Brandsted was intrigued by the positive outcomes being reported.
"The technology has changed tremendously," he said. "In years past, the early techniques weren't very satisfactory in terms of the side effects that it would cause and the inability to kill the cancer adequately."
Cryoablation, sometimes called cryotherapy, is done under general anesthetic. Needles are put into the prostate where the cancer is located, using ultrasonic guidance to make sure of proper placement, Brandsted explained.
"Usually six or eight needles are placed, along with four of what we call thermo sensor needles --- those are to detect when the ice ball is getting close to surrounding structures that we don't want to freeze," he said.
Argon gas goes through the needles and creates an ice ball, freezing the prostate from front to back, Brandsted said. The average freeze time is about eight minutes, and then the area is thawed and then refrozen a second time, usually for about six minutes, he said.
Part of the reason that cryoablation is finding new popularity is the changes in technology. Those thermo sensor needles help doctors keep from injuring surrounding structures, such as the rectum, which had been a problem in the past, Brandsted said. In the past, doctors didn't use the double-freeze technique and doing so now has made the procedure more effective, he said.
The way the procedure is done now has been shown to be so effective that some doctors are beginning to offer it as a primary therapy, rather than just a follow-up to cancers that recur after radiation therapy, Brandsted said.
"What has happened is that in the process of treating these (recurrent cancers), there has been such an acceptable, low rate of complications and side effects and highly effective treatment of the cancer, that some of the leading centers are doing this as a primary therapy and offer it as an equal to either surgery, external beam radiation or seed implant," he said.
There are possible negative side effects from cryoablation, although the frequency of those has been lessened, Brandsted said. In the past, patients who underwent the freezing procedure were almost all impotent afterward.
"That is no longer the case," he said. "The worst-case scenario for impotence is about 60 percent, and that number is greatly improved upon with newer, nerve-sparing techniques and aggressive use of post-treatment therapy."
While that 60 percent number may still seem like a high risk, Brandsted is honest about what his patients are dealing with.
"I think the thing that we always have to keep in mind is that we're dealing with a pretty serious problem, that is, cancer," he said. "And most men and their families, once they have gotten over the initial shock of the diagnosis, realize that the most important thing from that point on is to eradicate the cancer.
"While potency is most definitely an extremely important concern, the primary concern is to cure the cancer. That's the bottom line."
Recent research does offer hope. Unlike radiation, where there appears to be an acceleration of impotency over two to three years following the treatment, cryoablation shows the opposite, Brandsted said.
"There may be a fairly high incidence up front, but over two to three years, it improves and at about two to three years, there is essentially no difference between the potency rate with seed implant and cryoablation," he said.
Seed implant refers to a procedure that is similar to cryoablation. Needles are inserted in the prostate area where the cancer is, but instead of argon, radioactive seeds are put in place.
Brandsted said they are seeing an 80 percent to 90 percent overall cure rate for prostate cancer treated with cryoablation.
Morgan Chilson is a freelance writer living in Shawnee County. She may be reached at [email protected]
NOVEMBER 29, 2004
Cancer: Impotency secondary to cure
Please see CANCER, Page 6B
Continued from Page 1B