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Clinical Updates

 
Urology

Minimally invasive options increasing for prostate cancer treatment

06/01/2010

Minimally Invasive Prostate CancerProstate cancer represents a spectrum of related cancers, some more aggressive than others. When paired with differences among patients in their physical condition and willingness to tolerate various treatment risks, this range of prostate cancer disease creates the need for a range of treatment options. The UCLA Prostate Cancer Program has the expertise in a variety of medical and surgical disciplines to be able to offer the latest and most advanced care for patients with prostate cancer, including investigational therapies available only through clinical trials.

The primary trend in prostate cancer surgery has been toward less invasive approaches to treating prostate tumors. Surgeons have moved from radical extirpative procedures performed through large incisions — in which the prostate gland is removed in its entirety — toward minimally invasive or even ablative procedures when possible, where only the cancerous portion of the prostate is removed or destroyed. In addition, physicians have worked to minimize or even eliminate the incision needed to treat prostate tumors.

Minimally invasive surgery

The first step toward less invasive surgical treatment of prostate cancer is the use of laparoscopy, in which the standard incision is replaced with a few small openings through which the surgical scope and instruments are inserted to allow surgeons to visualize and manipulate the affected tissue. Laparoscopic surgery is further enhanced with the aid of surgical robotics, allowing surgeons better visual access and finer manual control.

Ablative procedures, such as cryotherapy, offer prostate cancer treatment that is even less invasive. A needle probe is passed into the affected area of the prostate under ultrasound guidance. The probe reaches extremely cold temperatures to freeze the targeted tissue, destroying the cancerous cells without removing the entire prostate gland.

While cryotherapy has been available for many years, advances in equipment have helped to make it a more effective treatment and have helped reduce the risk of side effects.

Treating tumors without an incision

External beam radiation and radioactive seed implantation are common treatment options for prostate cancer patients, and UCLA has considerable experience with these forms of therapy. ULCA is also a leader in developing and using stereotactic radiosurgery to precisely deliver high doses of radiation while limiting the exposure of healthy surrounding tissue.

UCLA is also at the forefront of a new completely non-invasive high-intensity focused ultrasound (HIFU) treatment that uses intensely concentrated ultrasound energy to rapidly heat and destroy tumor tissue without requiring an incision. Real-time diagnostic ultrasound is used to visualize the prostate and guide the treatment for greater precision.

HIFU is available at UCLA as part of a clinical trial for patients who have had a recurrence of prostate cancer following radiation therapy. UCLA is the only site on the West Coast currently offering HIFU therapy for prostate cancer.

UCLA Prostate Cancer Program

The UCLA Prostate Cancer Program consists of a team of physicians from a variety of medical and surgical disciplines working together to provide a full range of treatments. Each patient is offered a coordinated, individual program of care that best meets the needs of his medical condition and individual preferences. The program also offers treatments for non-cancerous prostate disease, including trans-urethral resection, laser procedures and microwave therapies for enlarged prostate.

The National Cancer Institute has designated the UCLA Prostate Cancer Program as a Specialized Program of Research Excellence (SPORE) in recognition of our work in translational research, including the discovery of biomarkers for prostate cancer and research into increasing the effectiveness of minimally invasive treatments for prostate cancer.

Participants sought for study

“The more we learn about cancers, the better we are able to match patients with the treatment options that will be best for them,” explains Allan Pantuck, M.D., associate professor of urology at the David Geffen School of Medicine at UCLA. “Our goal is to offer treatments that are highly effective in treating the prostate cancer while posing fewer risks and exhibiting fewer side effects.”

Enrollment is open in a UCLA clinical trial of high-intensity focused ultrasound (HIFU) to treat localized prostate cancer that has recurred after the use of external beam radiation (X-ray) therapy. Because of scarring, surgical removal of the prostate after X-ray therapy is a more formidable procedure than removing the intact prostate. The new treatment could fill an important gap in the currently available therapies by offering an effective, noninvasive treatment option for recurrent prostate cancer.

HIFU is currently available only as part of research studies in the United States. “UCLA’s selection as the West Coast site for this important trial has the potential to greatly benefit our patients,” says Leonard Marks, M.D., pro-fessor of urology. “We view this as a major addition to our prostate cancer work here in Los Angeles.”

Participating Physicians

Arie Belldegrun, M.D.
Professor of Urology
Chief of the Division of Urologic Oncology

Arnold I. Chin, M.D., Ph.D.
Assistant Professor of Urology

Jean B. DeKernion, M.D.
Professor of Urology
Chair of Urology

Mark S. Litwin, M.D., MPH
Professor of Urology and Public Health

Leonard S. Marks, M.D.
Professor of Urology

Allan Pantuck, M.D., MS, FACS
Associate Professor of Urology

Jacob Rajfer, M.D.
Professor of Urology
Chief of Urology Harbor-UCLA Medical Center

Robert E. Reiter, M.D.
Professor of Urology, Molecular Biology
Director of Urologic Research

Matthew Rettig, M.D.
Associate Professor of Medicine and Urology

Christopher Saigal, M.D., MPH
Associate Professor of Urology

Peter Schulam, M.D., Ph.D.
Professor of Urology
Chief of the Division of Endourology
and Minimally Invasive Surgery
Co-director of the Center for
Advanced Surgical and Interventional Technology (CASIT)

Robert B. Smith, M.D.
Professor of Urology

Contact Information
(310) 794-7700 Appointments and referrals
(310) 794-3566 Information about the HIFU clinical study, Malu Macairan, research coordinator
www.urology.ucla.edu





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