Prostate cancer and the best quality of life outcomes

Mr Taimur Shah
Consultant Urologist and Senior Clinical Lecturer
Imperial College Healthcare NHS Trust

Prostate cancer treatment and the best quality of life outcomes

If you are advised that you are suitable for Active Surveillance, that is the best option for maintaining quality of life as it involves no intervention, just monitoring.
This is suitable for patients with low risk cancer and probably a Gleason score of 6, sometimes even higher.

Remember that all men over 50 will have prostate cancer cells, but most of the time they are not aggressive and do not lead to cancer. In fact many Clinicians believe this low grade cancer should not even be classed as cancer. For more information click on Active Surveillance and gleason scores, click on the buttons below:

However, if you do require treatment then if at all possible, that is you have intermediate grade cancer, then focal therapy is the best option to maintain quality of life. Typically 40% of men diagnosed with prostate cancer, and not offered Active Surveillance, are suitable for focal therapy.

The chart below illustrates why focal is the best option. (With thanks to Professor Hashim Ahmed and his team at Imperial)

Focal Therapies

There are three focal therapy modalities, all described in detail in on this website. You can use the buttons below as a short cut to learn more about each of them.

They are:

• HIFU which is used to treat cancer lesions at the back  posterior) of the prostate, that is towards the rectum
• Cryotherapy, which is used to traet larger cancer lesions (>1.5mm) in the anterior (front) of the prostate
• IRE, Nanoknife which is used to treat smaller lesions in the anterior (front) region.

Table showing the incidence of side effects and effectiveness at treating prostate cancer

Your content goes here. this graph illustrates exactly why focal therapy is the best option for suitable patients, especialy those who want to avoid harm and continue to have an active sexlife. However it should be noted that for radical prostatectomy, if bilateral nerve sparing is an option, see later section, and you are under 60 with good erections, then there is a 75% chance that you will have usable erections, perhaps whilst taking pills such as Viagra, once you have fully recovered from the procedure.

So who is suitable for focal therapy?

The above slide illustrates the criteria for being suitable for focal therapy treatment of prostate cancer. Remember almost half of patients (40%) on average are suitable.

You are perfectly within your rights to ask and receive information from the hospital where you have been diagnosed what you Gleason grades are and the position of your cancer.
There is a link describing what Gleason scores is below.

Remember, if having read this page, you believe you may qualify for focal therapy, and it has not been offered to you, then you are perfectly within your rights to ask to be referred to a hospital and Urological Surgeon, either privately or on the NHS that offers focal treatment for a second opinion.

For more information on being referred for a second opinion, readd the pages on the Urological Surgeons and institutions that offer focal therapies. Thelist can be found immediately under under the Ti and T2 treatment heading. Click the button below.

What are the chances of the cancer recurring with focal therapy?

As can be seen from the table below, the failure free survival rate, that is the survival rate with no reoccurrence of prostate cancer, is at least as good as with robotic prostatectomy.

Further, focal therapy can be repeated if there is reoccurance. Further a robotic prostatectomy remains an option.

In summary. The research data suggests focal therapies are a very effective option with few side effects and no difference in risk of recurrance.