HIFU: "Lack of sufficient Data"

Despite the growing interest in HIFU therapy it remains an experimental procedure in localized prostate cancer. Focused ultrasound waves are directed through a bundling lens into the prostate. At the "hot spots" temperatures of around 90 degrees Celsius are achieved, which should destroy the tumor tissue. The HIFU technology (high intensity focused ultrasound) is increasingly asked for to treat localized prostate cancer. However, the method remains highly controversial among experts.

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Laser are safer than conventional resection of the prostate

“Men diagnosed with prostate cancer are still not thoroughly informed about urinary incontinence as a consequence of surgery prior to undergoing the procedure,”complains Dr. Stephan Neubauer, Urologist at the West German Prostate Center. Many men are affected by the involuntary loss of urine despite more advanced surgical techniques. However, details of the actual incidence are still incomplete. "For example the statistical numbers for urinary incontinence often differ vastly depending on the type of study they were derived from, e.g., how and when they were determined. Usually these numbers are far removed from realty," says Dr. Neubauer.

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MRT: Ist die Biopsie überflüssig?

Vor allem Patienten, deren PSA-Werte trotz negativer Biopsie weiterhin steigen und der Krebsverdacht bestehen bleibt, profitieren von der MRT-gestützten Biopsie.
Diagnose ganz ohne Biopsie? Immer wieder wird Patienten mit Verdacht auf Prostatakrebs suggeriert, dass eine Gewebeentnahme heute überflüssig ist. Stattdessen reiche eine Kernspintomographie (MRT) der Prostata aus, um den Krebsverdacht zu bestätigen.

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Prostate Cancer: Is biopsy still necessary?

Especially patients whose PSA level continues to rise despite a negative biopsy and for whom the suspicion of cancer remains do still benefit from the MR-guided biopsy.
Diagnosis entirely without a biopsy? Time and again, it is proposed to patients with suspected prostate cancer that nowadays a tissue sample is unnecessary, and that instead, a magnetic resonance imaging (MRI) of the prostate can sufficiently confirm the suspicion of cancer.

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Laser are safer than conventional resection of the prostate

“Men diagnosed with prostate cancer are still not thoroughly informed about urinary incontinence as a consequence of surgery prior to undergoing the procedure,”complains Dr. Stephan Neubauer, Urologist at the West German Prostate Center. Many men are affected by the involuntary loss of urine despite more advanced surgical techniques. However, details of the actual incidence are still incomplete. "For example the statistical numbers for urinary incontinence often differ vastly depending on the type of study they were derived from, e.g., how and when they were determined. Usually these numbers are far removed from realty," says Dr. Neubauer.

“Men diagnosed with prostate cancer are still not thoroughly informed about urinary incontinence as a consequence of surgery prior to undergoing the procedure,”complains Dr. Stephan Neubauer, Urologist at the West German Prostate Center. Many men are affected by the involuntary loss of urine despite more advanced surgical techniques. However, details of the actual incidence are still incomplete. "For example the statistical numbers for urinary incontinence often differ vastly depending on the type of study they were derived from, e.g., how and when they were determined. Usually these numbers are far removed from realty," says Dr. Neubauer.

Recent study assessing the realities of care

How many patients actually experience incontinence after prostate surgery has now been shown by a study that was published recently in the medical journal “Der Urologe.” In this study, a team of scientists assessed the medical records of all patients who received follow-up treatments in 2009 at the Klinik am Kurpark in Bad Wildungen following surgical removal of the prostate. Evaluated were 1750 patients with an average age of 65. Recorded were the age of the patient, PSA levels prior to surgery as well as the surgical procedure selected.

The result of the investigation cannot be any clearer: Three months after surgery, two-thirds of the patients were unable to hold their urine, despite the rehabilitation measures such as pelvic training. The degree of incontinence differed and ranged from urine leaks and wearing inserts and pessaries up to the permanent use of diapers. Conversely, only one third of the men left the rehab facility as continent. “The figures reflect the results we know from our daily practice," says the Cologne urologist. When and if at all, affected men can overcome their incontinence, remains currently still unknown. Generally, we can assume that the longer the duration of incontinence, the higher the probability that the patient cannot keep the urine even after 12 months.  Noticeable was also that no matter what the operating method had been, there was no difference in how frequent urinary incontinence occurred. Even the propagated particularly safe robot-assisted surgery did not protect against the dreaded loss of urine.

"The high incidence of urinary incontinence as a result of the surgery is all the more serious considering that many men with prostate cancer still undergo surgery unnecessarily," says Dr. Neubauer. As recommended in the guidelines for men with prostate cancer at low risk, it might therefore often be sufficient to monitor the tumor closely (Active Surveillance). “Should surgical procedures become necessary, it will be important to shift the focus more on achieving the best cure rates with the most minimal side effects,” so the urologist from Cologne. “It is therefore our duty,” continues Neubauer, “to alert the patient before the therapy to more effective but less invasive treatments, such as brachytherapy (internal radiation)."
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Literature: 
¹Lent V.Schultheis H.M., Strauß L. et al.: Belastungsinkontinenz nach Prostatektomie in der Versorgungswirklichkeit; Urologe 2013 – 52:1104-1109

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