Table of Contents

Chapter 2: Initial Treatment: Weighing the Pros and Cons of Each Option

e. Other Approaches: Cryotherapy, High-Intensity Focused Ultrasound, and Primary Hormone Therapy

Surgery and radiation therapy remain the standard treatment for localized prostate cancer, but that doesn’t mean that other, less popular treatment options might not be right for you.

Cryotherapy, also known as cryosurgery or cryoablation, has been around for years, but until a few years ago, it was rarely used. With this approach, probes are inserted into the prostate through the perineum (the space between the scrotum and the anus), and argon gas or liquid nitrogen is delivered to the prostate, literally freezing to death the prostate cells and any prostate tumors. Over the years, a number of modifications were made to avoid freezing damage to the nearby structures, but the rates for both erectile and urinary dysfunction remain high, and data on long-term outcomes are limited.

High-intensity focused ultrasound works in exactly the opposite way: the prostate cells are heated to death. A probe is inserted into the rectum, from which very high-intensity ultrasound waves are delivered to the target area. Although this technique remains experimental in the United States, it’s been used in Europe for a number of years with a fair amount of success.

Hormone therapy is a drug treatment designed to suppress the release and/or action of testosterone. As we’ll see in Chapter 6, because testosterone is known to fuel prostate cancer cell growth, blocking it is a commonly used strategy in men whose cancers are either not cured by local therapy or whose cancers are diagnosed at a stage when local therapy cannot be performed.

Although there is little, if any, data to show that hormone therapy alone is an effective treatment strategy for men with localized prostate cancer, it is increasingly being used in this setting. Because it is not invasive, it is possible that the therapy is seen as a middle ground between active surveillance and local therapy.

As time goes on and the benefits of these treatment options are further explored, it’s possible that they will move more into the mainstream. For now, though, none are seen as standard treatments for localized prostate cancer.