At the time of diagnosis, prostate cancer may be confined to the prostate itself, or may have spread to other sites within the body. If prostate cancer is confined to the prostate, it may be possible to cure it. The types of treatment that aim to cure prostate cancer when it is confined to the prostate include the following:
- HIFU
- Surgery (robotic or open radical prostatectomy)
- Hormonal manipulation
- External beam radiotherapy
- Brachytherapy (small implanted radioactive seeds)
All of the treatment options for prostate cancer mentioned above have possible side effects. The frequency of these complications / side effects varies slightly between treatment types, but the most significant are incontinence, impotence, infection, damage to the bowel and death. In order to help you compare the complication rates for a man having radical prostatectomy (surgery) are as follows: urinary incontinence requiring a pad 5%; impotence or inability to get or maintain an erection 70%; infection 5%; bowel damage 2%. Patients receiving radiation therapy have slightly different complications. These include radiation injury to the bladder and bowel. In most cases this gets better with time though in some men it can be long lasting.
Although the long-term results of HIFU are not known the side effects that occur as a result of treatment are well known. These results come from a number of studies that analysed the side effects that occurred in groups of men treated in Europe. In general the men were very similar to those reading this information.
In general urinary incontinence is not a big problem with HIFU. Studies show that few if any men had incontinence requiring pads, though 5% of men may experience dribbling of urine that was not considered troublesome. HIFU does require a catheter for up to 10 days after the therapy. This can cause its own problems of infection, blockage, bleeding. This will occur in about 10% of men. Some men will not be able to pass water once the catheter has been removed. Should this occur a new catheter will be placed and removal planned a week later. The options available to men if they are unable to pass urine normally after a second catheter is removed are outline above.
All prostate cancer treatments affect men’s ability to get and maintain erections. HIFU appears to be less detrimental to erectile function compared to other treatments. In the studies reviewed, between 45% and 70% of men reported preservation of erections sufficient for penetration. HIFU does not require blood transfusion, is not associated with any requirement for emergency surgery and there have been no treatment related deaths reported.
One of the key areas with regard to the safety of HIFU relates to rectal injury. Whilst cases of rectal injury were reported in the early experience of HIFU, recent reports show this event to be rare (less that 1%). Studies that have been published recently (2004) confirm rates of less than 1%. In one study of 148 men only one rectal injury occurred. This was in a man who had previous rectal surgery and long standing anal infection. There is no evidence that HIFU can lead to the spread of a tumour.
No other direct complications of the treatment have been recognised, but you would be strongly urged to mention any symptoms that you experience to your GP or urologist.
Patients that have failed radiation therapy (external beam radiotherapy or seed implant brachytherapy)
Patents who have failed radiotherapy have little in the way of potentially curative treatment options as no further radiotherapy can be given safely and surgery has a very high complication and side effect rate. Patients who are carefully restaged after radiation therapy with scans of the bones and pelvis, who have cancer in the prostate and not in the seminal vesicles on re-biopsy may be potential candidates for salvage therapy with HIFU with potential biochemical free progression rates of 60% at five years. Clearly salvage HIFU post radiation therapy failure has a higher complication rate in terms of incontinence, impotence and rectal injury, therefore careful treatment is required.