New technology is always associated with an aura of desirability. Three-dimensional television, the long-distance electric car, and innumerable medical therapies promising high cure rates with no morbidity all await validation as to their true worth. Such is the case with high-intensity focused ultrasound (HIFU) treatment of prostate cancer.
HIFU is one of the most appealing technologies to be directed at medical problems. In essence, energy from outside the body is focused precisely at a volume of tissue in the body. In a defined area, that tissue heats up rapidly and necrosis occurs. The body wall through which the energy passes is unaffected, and ultrasound imaging confines the damage to only those areas that need to be destroyed.
HIFU has been practised for over two decades — and yet remains controversial. Reports on the results vary considerably, from excellent cancer control with virtually no side effects, to high failure rates necessitating repeat treatments with significant morbidity. The feature article in this issue presents an interview with Dr. Laurence Klotz, a leading Canadian proponent of HIFU.
I agree with Dr. Klotz that HIFU is extremely appealing. But until its clinical benefit is defined in well-controlled trials comparing it to another standard treatment modality, I believe it remains, if not experimental, of uncertain benefit. The long-term side-effect profile of this treatment, including the effects of thermal coagulation of the prostate, is still of great concern.
Readers continue to send in their vital questions — please keep them coming! Dr. Tom Pickles looks at the use of digital rectal exam as a screening tool; Elizabeth Bowman, RN, explains the link between breast cancer and prostate cancer and the implications regarding genetic testing; finally, Pharmacy Manager Gregory Harochaw offers men tips on how to effectively use oral medications for erectile dysfunction.
We also hear from two prostate cancer survivors. Phil Read describes how he overcame setbacks in dealing with severe incontinence, finally deciding on a male sling implant (a minimally invasive surgical procedure) as the most suitable solution. Roger Thériault looks towards recovery and recounts how staying in top shape — both physically and mentally — helped him through his diagnosis and treatment.
We hope these and various other items in this issue will be of interest and help along your journey.
