Since decades, traditional forms of prostate cancer treatment – surgery and radiation – have included surgery and radiation, both of which often cause adverse side effects like incontinence or impotence.
New focal treatments provide more accurate, less damaging and invasive options. They may even be combined with more traditional therapies like hormone therapy or chemotherapy for enhanced results.
Photodynamic therapy (PDT)
Photodynamic therapy (PDT) utilizes a photosensitizer, an imaging agent and light applicator in tandem. Once accumulated in tumor cells, PDT activates to kill cancerous tissues while stimulating anti-tumor immune responses – representing an effective alternative to surgical intervention and other focal therapies. PDT combined with other therapies may further improve treatment efficacy.
PDT differs from traditional therapies in its use of non-thermal near-infrared light (NIR) to destroy tumor cells. NIR light absorbs into tumor cells, producing reactive oxygen species that create oxidative stress which kills them through oxidative stress; after being destroyed by immune systems such as the innate and adaptive, this leads to long-term tumor control.
PDT not only directly kills cells but can also trigger the release of certain cellular components and molecules to initiate an inflammatory response and initiate non-programmed cell death pathways such as pyroptosis, ferroptosis and paraptosis; which may help promote tumor regression while improving immunotherapy effectiveness.
PDT offers safer and less invasive alternatives to surgical, chemotherapy and radiation therapies; however, it should not be administered for large or diffuse tumors as well as people suffering from certain blood diseases. Furthermore, its photosensitizer may cause light sensitivity even months post-treatment; so special care must be taken with this procedure.
PDT may be effective at treating prostate cancer, but not for everyone. As a minimally invasive procedure that does not require surgery or active surveillance, PDT is ideal for patients at lower risk for recurrence who do not want active surveillance; alternative therapies like immunotherapy or local ablation techniques may enhance its results further. Its success, however, depends on its photosensitizer being absorbed by tumor cells; more effective photosensitizers must therefore be developed for wider application of this therapy.
Immunotherapy
The prostate gland is a small, walnut-shaped organ found within male reproductive systems. Located below the bladder and surrounding the upper portion of the urethra that drains urine out of the body, the prostate produces fluid that nourishes and protects sperm. Prostate cancer occurs when abnormal cells within this organ develop and spread uncontrollably.
Immunotherapy works with your immune system to attack cancer. Two FDA-approved immunotherapy treatments exist for prostate cancer treatment and promising research is currently ongoing to develop immunotherapy-based solutions to treat metastatic prostate cancer.
These medications, known as checkpoint inhibitors, target proteins that inhibit your immune system. By targeting them specifically and increasing their effectiveness during cancer treatments, checkpoint inhibitors may significantly increase chances of survival and extend survival periods.
Immunotherapy for prostate cancer includes vaccines and cellular therapies. Cellular immunotherapy uses your own immune cells to fight the cancer; treatments may be given in cycles; your medical oncologist will discuss what schedule best fits your situation.
Radiation therapy, using high-energy waves such as X-rays or electron beams to kill cancer cells and shrink tumors, is another viable treatment option for prostate cancer patients. Radiation therapies often used in combination with surgery and other forms of therapy include external radiation therapy and brachytherapy; external radiation therapy utilizes an external machine for direct radiation targeting the cancer, while brachytherapy places radioactive seeds or pellets directly inside or near tumors to destroy them.
Hormone therapy, which works by blocking hormones cancer cells need for growth, may make certain tumors more responsive to immunotherapy by drawing immune cells toward them; however, its benefits are temporary as hormone therapy increases levels of an immune cell known as Tregs that act as brakes on our ability to attack cancer.
Immunotherapy has evolved to counter these side-effects. One such strategy utilizes a drug that binds to immune cell surface proteins that promote Treg growth – in this instance a Mayo Clinic team has demonstrated that by combining this approach with other cancer treatments it can drastically decrease both cancer cell numbers and tumor severity even among advanced stages of cancer patients.
Focal ablation therapies
Focal ablation therapies can be used to safely destroy abnormal or diseased prostate tissue without harming surrounding nerves and structures, helping preserve urinary and sexual function while also mitigating side effects associated with traditional prostate cancer treatments like surgery and radiation therapy. These minimally invasive procedures typically can be completed within a few hours with shorter hospital stays than more invasive therapies.
Focal ablation therapies use extreme temperatures such as freezing, heat or electricity to destroy cancerous cells and abnormal or diseased tissue. Techniques vary based on the location and size of the tumor. Common examples are cryoablation, photodynamic therapy and laser or high intensity focused ultrasound; all available to those with low- to intermediate-risk prostate cancer.
At focal ablation, your doctor will begin by administering anesthesia so you won’t feel any discomfort during the procedure. He or she will then insert a small device into your rectum or urethra to reach the target area – this procedure typically lasts about 2.5 hours and you should plan to stay overnight in hospital; you may require catheter placement for three days as well as post-treatment restrictions or recommendations such as lifting restrictions and post-treatment recommendations.
Vitus Private Clinic’s team of prostate cancer experts specialize in tailoring their approach to meet individual patient needs, and can offer cutting-edge focal treatments.
Your urologist will go over all the details of focal ablation therapy with you, taking into account factors such as tumor size and location within the prostate gland, PSA level type and whether any symptoms exist; additionally they will evaluate whether your disease can be treated effectively.
Once you have undergone focal ablation therapy, your urologist will monitor for signs that disease has returned or spread. They will examine PSA levels, MRI scans, prostate biopsies (and additional ones if needed) to detect cancer spread; should this happen they will recommend additional treatment or an alternate focal ablation therapy plan as soon as possible and could even suggest clinical trials testing new prostate cancer drugs or combinations to try first.
Clinical trials
Surgery, radiation therapy and hormone therapy are among the many treatment options for prostate cancer; your doctor will select one based on its stage, grade and spread potential.
Men with low- or intermediate-risk prostate cancer often opt for active surveillance, which involves closely tracking their disease by taking PSA tests and having biopsies performed regularly, treating symptoms only if needed and deferring treatments until the cancer grows or causes growth or spread. High-risk patients may opt for treatment instead.
Men whose cancer has advanced may receive systemic treatments like hormone therapy and chemotherapy; however, these can have significant side effects and even become resistant over time.
Researchers are exploring less toxic, targeted treatments for prostate cancer. One such therapy, focal ablation therapies, are designed to target only where the tumor exists while sparing nearby tissues from harm. Utilizing energy sources like lasers, ultrasound or radioactive particles these treatments may offer less side effects such as impotence and incontinence than their counterparts.
Recent research demonstrated the efficacy of using both HIFU and PDT together as an effective means of lowering PSA levels, decreasing tumor volume, and improving urinary function for some men with low or intermediate-risk prostate cancer. Cryotherapy uses liquid nitrogen to destroy prostate tissue but doesn’t preserve tumour antigens for immune recognition as effectively.
Radiation therapy may be administered externally (External Beam Radiation Therapy) or internally by placing radioactive seeds into the prostate gland, or using proton therapy – which uses an electron beam – directly on tumorous tissue rather than surrounding healthy tissue – but radiation may damage healthy cells, leading to side effects like incontinence, erectile dysfunction, bowel issues or impotence in individuals receiving treatment.
Many men turn to complementary or alternative medicine in an effort to manage side effects associated with prostate cancer treatment, but it’s essential that they consult their physician first in order to make sure any supplements or natural therapies won’t interact negatively with any current treatments they might be undertaking.