Surgery-free cure for prostate cancer?

New Delhi: Curing prostate cancer — the most common non-skin cancer in men — may no longer require a surgery. And what’s better, it could take just 1-4 hours time, with patients walking out of hospital in two days flat.

 Urologists in India are trying out the High Intensity Focused Ultrasound (HIFU), a new technology that does not require the removal of the entire prostate gland. Instead, it “cooks the prostate tissue” with ultrasound beams, passed by a robotic arm through the patient’s rectum, destroying and evaporating all the cancerous cells.

HIFU is a one-time procedure performed under regional anesthesia and can completely cure prostate as large as 40 grams. Conventionally, surgery has been the only approach for treating many solid tumors, benign or malignant. Dr N P Gupta, president of Urological Association of Asia, says a study in 1992 had said that 6.7 per lakh population in India suffers from prostate cancer. At present, the prostate cancer surgery of choice is a robotic radical prostatectomy, in which the prostate gland and attached vesicles are removed. It is done via five to six keyhole incisions made in the abdomen. According to urologist Dr Ramesh Ramayya from Hyderabad, a radical prostatectomy, however, can lead to loss of urinary control in patients and also result in male impotency.

Gupta said around 10% patients who undergo radical prostatectomy may suffer from incontinence.

Dr Ramayya said, “Around 60% of patients also become impotent post the prostatectomy. Those who are treated by HIFU don’t suffer from incontinence at all. Only 20% in this category may suffer from impotency.”

Dr Gupta, who is also head of urology at AIIMS, said HIFU is best suited for small sized prostrates. “The normal volume of a prostate is 20 grams. HIFU is highly effective in prostates as big as 40 grams. Even though HIFU seems to be the technique of the future, at present, it’s under clinical trial and we don’t know it’s long term efficacy,” he added.

Explaining HIFU, experts said it is non-invasive. A small probe inserted into the rectum emits ultrasound waves directly to the prostatic tissue. Ultrasound energy is focused at a specific location which kills the cancer cells. In the focal zone, the temperature is rapidly elevated to 90 degrees celsius in a matter of seconds which causes tissue destruction. During HIFU, the entire prostate is treated or ablated.

Dr Ramayya said, “The treatment is pain free. People can return to a normal lifestyle within a couple of days.” “During the procedure, the probe constantly delivers real-time images of the prostate and the surrounding area, giving the physician immediate and detailed information,” he added.

Dr Ramayya, who has till now successfully cured three prostate cancer patients with HIFU, will demonstrate the technique at the international symposium on diseases of the prostate gland at All India Institute of Medical Sciences on Saturday. According to Dr Gupta, the disease of the prostate gland is a global problem with the increase in aged population. The prostate is a small gland that is part of the male reproductive system. It lies just below the bladder and in front of the rectum. Prostate cancer is usually very slow growing and is most common among men between ages 60 and 80.