Other Therapies for Localized Prostate Cancer
Surgery and radiation therapy are the current guideline-approved “ definitive treatments ” for localized prostate cancer, but other options are also available. These may be considered for carefully selected patients with low-risk and favorable intermediate-risk cancers (i.e., patients with Gleason 6/Grade Group 1 disease who do not elect active surveillance, and some patients with Gleason 7(3+4)/ Grade Group 2 prostate cancer).
► Cryotherapy is rarely used, and rates of side effects are high when it is applied to the entire prostate. Prostate cancer cells are frozen to death via probes inserted into the prostate through the perineum (between the scrotum and anus). Cryotherapy may be used for prostate cancer that has come back.
► High Intensity Focused Ultrasound (HIFU). In HIFU, the prostate cells are“heated” to death with a probe that is inserted into the rectum and produces high-intensity ultrasound energy.
► Proton Beam Radiation Therapy. Protons are a type of radiation treatment similar to photons(traditional X-ray radiation therapy) in many ways. However, in prostate cancer, proton beam therapy has not been shown to improve outcomes over other forms of radiation therapy. There have been no completed head-to-head trials comparing proton beam radiation therapy to either surgery or photon beam radiation therapy. Insurance companies often do not cover it(unless you are participating in a research study) and it is typically very expensive.
► Focal Therapy. This is a general term that refers to treatments that target just a region of the prostate thought to have the tumor, instead of treating the entire prostate gland. None of the therapies have yet been proven to have the same long-term success as surgery or radiation therapy in large clinical trials and are still considered investigational treatments.
The likelihood of recurrence is high with focal therapy, due to the fact that in over 80% of cases, prostate cancer is actually “multi-focal, ” meaning even if the biopsy and/or MRI showed the cancer to be in only one area, there is likely tumor in many areas of the prostate. If considering focal therapy, it is recommended to seek care at a high-volume center of excellence with extensive expertise in focal therapy. Appropriate patient selection is key to minimizing treatment failure, and patients are encouraged to enroll in clinical trials given the still-experimental nature of these procedures.
Last Reviewed: 12/2023
