I would like to continue discussing my previous entry about cryoablation for prostate cancer. If you recall, I mediated an UsToo Prostate Cancer Support Group Meeting discussing prostate cryoablation. A gentleman asked a very intriguing question: "Do you have to treat the entire prostate gland if a man has prostate cancer?"
This is a very controversial subject. To begin, we need to relate treating prostate cancer like general surgeons treat breast cancer for women. For many years, if a woman had breast cancer, they were recommended complete removal of the breast, called a mastectomy. As time went by and research continued, surgeons realized that the entire breast did not need to be removed in many cases. It was discovered that if a woman had breast cancer, it was usually in one location, not many different areas or "multifocal." Now, women are recommended that only the cancerous growth be removed, not the entire breast. This is called a lumpectomy. Therefore, they are spared a radical surgery with scarring affects. However, they may require chemotherapy and radiation in addition to the lumpectomy.
So, why not treat only the cancerous area in the prostate gland? One reason: prostate cancer usually is multifocal; in other words, the cancer is in different areas within the prostate gland. In 1972, a landmark study by Dr. D. Byar showed that prostate cancer was located in multiple sites within the prostate gland in 85% of men with prostate cancer. That means if a 64 year old healthy man with a PSA of 5.9 ng/ml has a prostate biopsy and it reveals 3 positive cores on the right side, there is an 85% probability that he has cancer in other locations within the prostate gland. These spots may be too small to discovered by the biopsy.
What are the options for this man? They include surgery, brachytherapy (seed implant), external beam radiation, cryoablation, watchful waiting or hormonal therapy. For argument's sake, let's say this man only wants the cancerous area treated. He does not want his entire prostate removed by surgery or his entire prostate radiated or cryo-treated. It is feasible to partly or focally treat his gland by cryoablation. There are a few doctors in the country trying this technique. The urologist would only cryoablate the cancerous region found on the biopsy. The rest of the gland is not treated. The reason to do this is to reduce the side effects such as urinary leakage (incontinence) and erectile dysfunction.
However, if a doctor partly treats this man'sprostate gland, the patient will have untreated cancer cells continuously growing and dividing. It has not been accepted by urologists, oncologists and radiation oncologists to partly treat a man's prostate cancer. This is experimental, and to my knowledge there are no studies looking at this controversial subject. A man must understand the significant risks while undergoing partial treatment of his prostate cancer.