Here are expert answers to common questions about a prostate cancer experience, particularly regarding radiation procedures, from the recent CURE® Educated Patient® Prostate Cancer Summit chaired by Dr. Kelly L. Stratton of Oklahoma University Health.
Is brachytherapy an ablative procedure?
Brachytherapy is a form of radiation therapy, where radioactive seeds are implanted into the prostate and kill the prostate cancer. Alternatively, ablative therapies use an energy source, such as ultrasound, to create thermal energy (heat) that kills the prostate cancer and ablates the tissue.
If there are lesions on both sides of the prostate, can HIFU still be performed?
Occasionally, but the more prostate cancer present, the more treatment is required, so that can limit the benefit of focal therapy.
Glossary
Definitions are from the National Cancer Institute.
High-intensity focused ultrasound therapy (HIFU): A process where high-energy sound waves are aimed at abnormal cells or tissue, creating heat to kill the cells, according to the National Cancer Institute.
Transurethral ultrasound ablation (TULSA): A process using an ultrasound device guided by MRI imaging to deliver high-energy sound waves, producing very high temperatures to kill cancer cells, according to the National Cancer Institute.
PSMA PET scan: An imaging test to find prostate cancer cells in the body, according to the National Cancer Institute.
Are each of these types of focal therapies covered by original Medicare for the treatment of prostate cancer?
Although coverage can vary, HIFU is typically covered by Medicare, but TULSA is not yet covered by insurance. We hope that TULSA coverage will start sometime next year, but the timeline is not clear yet.
To treat local recurrence following initial external radiation treatments, what issues might complicate using these focal therapies?
There are several factors that we consider: the location of the cancer, potential prostate calcifications, the size of the prostate, involvement of the seminal vesicles, location of prostate fiducial markers and the aggressiveness of the cancer.
Prior to focal therapies, do you always do a PSMA PET scan?
Not always, but sometimes. If the MRI is very clear, it may not be necessary to get a PSMA PET.
Assuming that you have a recent MRI that shows the prostate lesion, is a recent biopsy also required prior to having either a HIFU or TULSA PRO treatment?
In practice, I recommend that men have a biopsy of any new prostate lesion. I think it can help guide treatment options like HIFU and TULSA. It can also provide information about how aggressive any cancer is and that can help with treatment decision-making.
If the prostate lesion is only on the anterior side of the prostate, is TULSA PRO a preferred treatment over HIFU, because the RF energy source is closer to the lesion that will be burned?
Anterior lesions can be challenging to treat with HIFU due to the source of energy, which is located in the rectum and traveling upward and near the urethra. It is possible to treat some anterior lesions with HIFU. Conversely, TULSA treatment is administered from the urethra. So there may be an advantage in treating anterior lesions. Both treatments are image-guided, so having a urologist review those images and determine the treatment plan could guide that decision.
Is proton beam therapy another emerging "ablation" option to HIFU and TULSA PRO for a prostate lesion?
Proton therapy is a form of radiation therapy that uses radiation to kill the prostate cancer, typically treating the entire prostate. Ablative therapies use energy, such as ultrasound to kill the prostate cancer by thermal ablation (such as heat).
What type of biopsy is done a year after TULSA?
Usually, it is a biopsy similar to the biopsy that was done prior to diagnosis of prostate cancer. For instance, a transperineal prostate biopsy. It may also target any index lesion or prior area of cancer.
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