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Focal Therapy for Prostate Cancer: Does It Actually Work? · Intellectual Medicine

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  Focal therapies do not come without risk.
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  They all come with inevitability that will be a significant
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  failure rate with progression of disease.
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  They don't have as much negative consequence, but do they really
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  make a difference or are we simply cashing in on men who
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  have very early stage indolent prostate cancer that is best
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  left not disturbed and treated with lifestyle nutraceutical
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  repurposed drug therapy with non invasive monitoring treating
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  prostate cancer. What a dilemma.
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  There's been a rise lately in focal therapies.
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  We're going to discuss those today.
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  What is a focal therapy? Does it have merit?
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  Let's start out with why the focal therapies are on the
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  ascension. There's several variables.
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  One of them, the conventional treatments, are God awful and
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  have not been shown to be substantially better than doing
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  nothing with regard to dying from prostate cancer.
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  That is, after all, the objective, isn't it?
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  We all got to die of something. We do not want to die of
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  prostate cancer, and we want to do things to diminish the
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  likelihood. Unfortunately, prostate gland
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  removal and radiation have not been shown to have that value,
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  and they're awful. Side effects are abominable, so
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  there's an opening for new treatments.
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  Now there's also a capitalistic Dr. I'm not against capitalism,
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  but we have to be have to be a little bit skeptical when new
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  equipment comes to the medical marketplace.
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  Now here's how it works, folks. Medical equipment is not FDA
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  approved. The equipment is FDA cleared.
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  That means that it's been shown to be reasonably safe,
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  reasonably effective for a specific purpose.
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  Now, once a device has been cleared and it can be sold to
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  doctors, they can use it for whatever they choose.
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  That's off label use. That's cool.
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  That's what I do in my repurposed drug therapy, off
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  label use. It's a it's using the doctor's
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  experience, skill, knowledge to apply the technology toward a
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  space in which it's not previously been approved.
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  So that's ethical, legitimate, but the problem lies in the
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  motivational dynamics. What do I mean?
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  Device gets approved, it gets cleared, FDA cleared.
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  There's often millions of dollars in investigative studies
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  to get it to that level. They need ROI, they need return
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  on investment. And to get that, they've got to
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  promote this as advantageous. Now, this is replete in the
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  world of prostate cancer treatment.
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  Men do not want to have, they don't want to suffer at the
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  hands of ablative therapies. Many of you are reading about
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  this, you're hearing about it from me, from other credible
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  sources, and you are rightfully hesitant.
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  Problem with these focal therapies?
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  None, not one. There's not a focal therapy yet
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  that has been shown to diminish your risk of dying from prostate
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  cancer. Those studies can take 20 years.
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  It doesn't mean that they may not ultimately show that value,
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  but so far, the early returns are a little disappointing.
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  Now, what they have in common. We'll discuss individual focal
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  therapies in a moment. What they have in common is the
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  concept that you can identify where the prostate cancer is by
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  virtue of an imaging study, an MRI in particular, maybe an
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  ultrasound, and go in there and ZAP it.
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  That is, kill the cancer cells and spare everything else.
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  All right, that's just foolhardy.
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  Cancer of the prostate, and for for that matter, elsewhere, is a
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  cellular disease. It metastasizes without leaving
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  a trace, without visible evidence.
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  Cellular escape. So no matter what you do to
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  address your prostate cancer, this does become a lifelong
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  endeavor. You can never be certain if
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  those cells have escaped the target if they're going to plant
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  in the bone, in the liver and come back 5-10 years later.
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  So the point is not to be pessimistic and say, oh, it's
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  hopeless. After all, the cells will
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  escape. No, we want to combine things if
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  if, if needed, we want to combine things to go after the
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  cells. Even if you're doing a focal
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  ablation because a focal ablations may have an itch.
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  My concern about them in addition to the fact that
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  they've not been proven at the back end.
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  We don't need absolute proof to advocate for a treatment, by the
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  way, right? What we need is evidence of
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  benefit and safety. We don't want to cause harm.
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  The ablative therapies don't measure up to that standard, in
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  my view. So let's start with focal laser
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  ablation. The focal laser ablation is
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  based on equipment that has not been FDA cleared to treat
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  prostate cancer. It is cleared for the
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  destruction of tissue, and doctors have applied it toward
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  the prostate because, after all, they're trying to destroy cancer
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  tissue. It's a rational extension, but
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  it doesn't work out so great. It involves A surgical procedure
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  with anesthesia, inserting a probe through the perineum into
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  the prostate gland. And right away we got problems,
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  right? We're piercing the capsule,
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  We're introducing trauma with the potential of metastatic
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  disruption that can happen. And piercing the capsule has a
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  risk of metastatic spread even if it's followed by an ablation.
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  So the laser goes in through the capsule and zaps the area of
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  concern. Still some incidence of erectile
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  difficulty, still some incidence of urinary difficulties,
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  although much less than conventional treatment.
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  So I guess it's got that going for it.
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  The other problem in two different studies, one study
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  showed one year later, 29% of the men had recurrence of
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  prostate cancer cells in the gland.
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  That tells me a couple of things.
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  Number one, they had a high incidence of treatment failure.
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  Number 2, they had to get biopsies to get that
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  information. So you're still stuck in the
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  conventional, you know, Whirlpool of biopsy assessed
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  biopsy. You know, which I don't
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  advocate. I do not advocate biopsies.
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  If you've had them in the past, you can't undo the past.
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  But think twice, go back. Look at my podcast.
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  Another study on focal laser ablation found a 15 to 56% rate
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  of cancer cells being present 12 months later.
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  That's not so good. You're going through the
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  ablation and in many times you're paying for this out of
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  pocket, folks. You go through that ablation,
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  right? You expect cancer to be gone,
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  but it's cellular, it's tenacious, and it's going to
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  linger. It's hard to know for sure if
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  those cancer cells are gone. The other problem with focal
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  laser and other focal therapies, they are specifically utilized
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  for men with low risk prostate cancer.
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  Now you know I do not advocate a biopsy, which means I do not
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  advocate getting a Gleason score.
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  Go back and look at my podcast on that topic.
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  Gleason scores are not needed to guide thoughtful treatment
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  decisions, nor are they needed to determine how aggressive
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  cancer is. You can do that with sequential
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  assessments, but the biopsy becomes fundamental to this.
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  In the case of laser therapy or focal ablation therapy, they're
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  treating men with the most indolent form of the disease.
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  In other words, men who never needed to have surgical
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  intervention and all likelihood and have a high likelihood of
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  thriving with something like the repurposed drug therapy that I
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  advocate. So should you consider focal
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  therapy? It's reasonable to contemplate,
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  but go in there with your eyes wide open.
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  Make sure you shop before you buy.
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  So focal laser ablation, it's got some liabilities.
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  How about high intensity focal ultrasound or high food?
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  It's been around for quite a while, since at least 2010.
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  With this one is a little different.
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  The probe goes in the rectum and the high intensity focal
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  ultrasound happens externally going through without piercing
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  the capsule. So it does have that advantage,
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  non capsule disruption. It just doesn't work that great
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  to prevent cancer from progressing.
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  In one review article looking at 10 years of HAIFU results, they
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  found 50% of the cases had progression of cancer.
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  So if you do HAIFU, you've got to be diligent.
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  It's not going to be a circumstance where the treatment
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  cures you and you don't have to sweat.
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  You want to continue monitoring the other treatment approach,
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  cryotherapy. Now, cryotherapy involves once
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  again going through the perineum, inserting a probe into
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  the prostate and freezing it, usually with argon gas, making
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  an ice ball out of the prostate. Now, what I like about that
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  conceptually is we're not trying to pretend that we can target
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  specific spots where cancer is likely to be.
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  We're freezing the whole damn prostate, a big ice ball, and
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  that kills cancer cells, and it kills prostate cells as well.
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  It affects both, and as you might expect because of its
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  global impact, is a higher incidence of erectile
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  dysfunction with this treatment than with other focal therapies.
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  But in studies looking at its long term outcome, it was shown
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  to be no better than active surveillance.
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  Now, active surveillance, as you probably know by now, is simply
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  medspeak for doing nothing. Well, we're going to do active
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  surveillance. It sounds nice.
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  I like being surveyed. I like it to be active as
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  opposed to passive. But it is a fallacy.
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  We're going to simply watch your cancer by doing periodic
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  biopsies to tell what it's how silly when you know cancer is
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  present, why would you stick a needle in it?
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  So anyhow, the cryotherapy no better than effectively doing
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  nothing with regard to long term outcome.
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  A more recent procedure called the Tulsa All Capitals Tulsa
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  stands for transerethal laser therapy.
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  It involves going through the urethra.
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  So this does have an advantage of not piercing the capsule,
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  right, going through the urethra, that's better.
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  And then it uses the energy of the laser extending outward in
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  order to heat and and then destroy the prostate cancer
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  cells. So conceptually it has some
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  advantages goes through the urethra rather than through the
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  the capsule. It extends outward from the
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  urethra destroying the cells. So hopefully there'd be less
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  incidence of metastatic spread. To date, it's a relatively new
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  procedure and that that statement can't be verified
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  right. So the potential for spread does
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  exist. In one study looking at this, 10
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  out of the 23 individuals who had Tulsa done had cancer
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  present 12 months later, 10 out of the 23.
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  It's a high incidence of failure in a treatment that is intended
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  to be definitive or at least therapeutically effective.
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  It's a problem because it's not obliterating the cancer.
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  The good news, at least it's not as traumatic as prostatectomy or
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  radiation. I don't advocate for either
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  other big study. There was a study that looked at
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  150 men. This was a study that helped it
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  to get FDA cleared for treating prostate cancer. 35% of the men
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  a year later in the study still had prostate cancer.
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  Which I suppose if you flip it around, 65% did not.
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  One year later? What about three 5-10 years?
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  The nature of prostate cancer is such that we could expect the
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  failure rate to increase over time.
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  Is it worth getting? Well, it's better than having
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  the gland removed. It's better than radiation.
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  It doesn't have as many side effects.
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  I like it conceptually better than piercing the capsule like
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  laser therapy, like cryotherapy, but it's pretty brand new and
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  it's currently being utilized in men with very early stage
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  disease. And it's an out of pocket cost.
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  10s of thousands could be up to 30,000.
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  That'd be sweet if it were one and done and you had a high
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  degree of confidence it's going to take care of the problem.
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  There is an incidence of erectile dysfunction with this.
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  In one study of 13 men who had no problem with erection before
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  the procedure, seven of them, 7 out of 13, developed erectile
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  difficulty afterward. It's not exactly as it was
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  promoted. So as you can see, focal
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  therapies do not come without risk.
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  They all come with and that inevitability that will be a
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  significant failure rate with progression of disease.
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  They're better than focal. They're better than having the
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  gland removed. They're better than radiation
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  therapy. With regard to the negative
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  consequence, they don't have as much negative consequence, but
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  do they really make a difference or are we simply cashing in on
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  men who have very early stage indolent prostate cancer that is
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  best left not disturbed and treated with lifestyle
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  nutraceutical repurposed drug therapy with non invasive
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  monitoring. That's the real comparative
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  assessment that we care about. That'll never happen in an
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  organized study, but it is happening in real life, in real
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  time as we speak. Men are choosing to pursue the
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  protocols that I've advocated, and by virtue of their choice,
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  we are now gathering experience data over years.
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  Well, we'll be sharing that with you as it continues to unfold.
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  But today, today was about focal therapy.
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  Do your homework, take time. Remember, there's never an
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  emergency when you're looking at localized disease and
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  contemplating what to do. Take your time.
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  Make a decision that prioritizes your vitality and values what
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  you value. Feeling strong, staying vital.
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  Do not compromise your masculine health out of a false promise of
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  disease cure. All right gang, that's all I got
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  for today. We'll be talking again soon.
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  Thanks for tuning in, Talk to you next time.