Partial Gland Ablation for Localized Prostate Cancer
- Partial gland ablation is a new treatment for localized prostate cancer, targeting only the cancerous area.
- Currently this is not the standard of care and more studies are needed comparing this approach against surgery and radiation
- It preserves normal functions with fewer side effects compared to traditional treatments.
- However, there is a risk of residual cancer and potential complications.
- Follow-up tests are necessary to monitor progress and detect any recurrence of cancer.
Partial gland ablation, also called focal therapy, is a minimally invasive procedure that zeros in on the cancerous area within the prostate while avoiding the rest of the gland and the surrounding areas.
Read MoreWhat is partial gland ablation?
Partial gland ablation destroys the part of the prostate that has cancer, while leaving the rest of the prostate and the nearby organs alone.
Because of its ability to isolate the cancer, it usually causes fewer problems with peeing, sex, and bowel movements than are common with other treatments.
However, it’s a relatively new approach to treating prostate cancer and not yet considered a standard treatment for prostate cancer.
For now, it’s offered only available in some clinical trials and a few specialized centers.
Who is a good candidate for partial gland ablation?
Partial gland ablation may not be suitable for everyone. You and your doctor will carefully consider if it’s a good choice for you.
Ideal candidates:
- Have a small area of cancer that has not spread beyond the prostate
- The cancer is serious enough to need treatment but not aggressive treatment.
- There is enough space to destroy the cancer without hurting nearby organs.
How does partial gland ablation work?
Partial gland ablation uses different types of energy to kill the cancer cells. Each type of energy has its own advantages and disadvantages.
- Heat: Ultrasound or radiofrequency waves destroy the cancer cells by raising their temperature. While effective, it also runs the risk of bleeding or damaging surrounding areas.
- Cold: Gas or liquid destroys cancer cells by freezing them. This is also effective but also may damage the surrounding normal tissue or lead to infection.
- Lasers: Light or electric pulses kill cancer cells by burning them. This is a newer and less invasive type of partial gland ablation, but still may hit surrounding normal tissue or cause swelling or scarring.
- Chemicals: When injected into the prostate, chemicals can destroy the cancer cells by poisoning them but may also damage the surrounding normal tissue or cause allergic reactions or toxicity..
The choice of energy depends on several factors, such as the size and location of the tumor, the availability of the technology, and the expertise of the doctor.
“Under anesthesia, the ablation is done in any variable amount of time,” Dr. Wysock says. “As for an outpatient procedure, anywhere from 20 minutes to an hour or so, men go home the same day.”
What are the possible side effects or complications of partial gland ablation?
While it does have fewer side effects than many other prostate cancer treatments, partial gland ablation may still cause complications.
- Bloody urine
- Urinary tract infection
- Erectile dysfunction, reduced ejaculation, or loss of sensation. (Rare and usually temporary with treatment.)
- Rectal injury, bowel problems, or fistula. (Rare and serious. May require surgery or other treatments.)
- Some cancer may remain or come back
The risk of complications can be reduced by choosing a qualified and experienced doctor and discussing any concerns with your doctor as soon as possible.
Related: A Promising New Prostate Cancer Procedure with Lower Risk of Impotence
What does the evidence show?
Partial gland ablation is still relatively new which means doctors are still finding out about its long-term results and safety.
Dr. Wysock himself, has conducted research on the outcomes and follow-up of partial gland ablation using cryoablation (cold) and high intensity focused ultrasound (heat or HIFU).
Based on available evidence, partial gland ablation seems to have some benefits and some limitations.
Benefits:
- Eliminates a significant portion of cancer within the prostate. One study found that 75% of patients had no cancer in the treated area after 6 months.
- Reduces need for additional treatment later on. More than 65% of patients in one study required no further treatment 5 years on.
- Preserves normal prostate and nearby organ functions in the majority of cases, with most studies indicating that patients can maintain normal urination and sexual function post-treatment.
Limitations:
- It may not get all of the cancer. Up to 30% of patients still have some cancer remaining a year after the procedure, studies suggest.
- A small chance cancer may spread. In one study, nearly 2% of patients developed cancer in other locations after 5 years.
- Side effects or complications such as blood in the urine, urinary difficulties, or infections following treatment.
Another factor to consider: cost.
Insurance coverage depends on the provider, the center, and the policy. Some centers offer partial gland ablation as a cash pay only service, while others accept insurance and work with reimbursement experts to keep out-of-pocket costs down.
You may also qualify for coverage under Medicaid or Medicare, if you meet certain criteria.
Be sure to discuss coverage and expenses with your care team.
Related: Cost of Prostate Cancer treatment
What is the difference between whole and partial gland ablation?
Another more established and widely available technique in prostate cancer treatment is called full gland ablation. As the name suggests, this procedure destroys all of the prostate tissue. It’s often used as “salvage therapy” after radiation therapy fails or the cancer recurs.
Both techniques are approved by the US Food and Drug Administration (FDA).
Both have advantages and disadvantages, depending on the stage and aggressiveness of the cancer, the size of the prostate, and the patient’s preferences and goals. Full gland ablation is more likely to destroy all of the cancer but also carries more side effects such as bladder, bowel and sexual function problems.
“Whole gland treatments remain the gold standard for prostate cancer, but a lot of why they remain the gold standard for prostate cancer is that they have been around before the MRI and disease localization got accurate enough to tell us where to go. A partial gland treatment would say if this is the location of the only site of significant disease, we treat that area and that area alone,” Dr. Wysock comments.
Does partial gland ablation require any follow up?
After having the procedure, follow-up tests or visits may be done every 3 to 6 months for the first year, then every 6 to 12 months for the next few years, and then once a year.
Doctors will monitor progress with the following tests:
- Prostate-specific antigen (PSA) test: A blood test that measures the level of a protein made by the prostate. A high or rising PSA level may indicate that the cancer is still present or has come back.
- Multiparametric magnetic resonance imaging (mpMRI): A special scan to create detailed images of the prostate and the surrounding tissues.
- Biopsy: Involves taking small samples of tissue from the prostate and examining them under a microscope.
- Physical exam: May also include a digital rectal exam that involves feeling the prostate with a gloved finger through the rectum.
Questions for your doctor
Here are some simple questions to ask your doctor about partial gland ablation:
- Am I a good candidate for partial gland ablation?
- What are the risks and benefits?
- What is the risk of side effects or my cancer returning?
- What are the associated costs and coverage?
- Are there any ongoing clinical trials or research studies that I may be eligible for?
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