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Bringing the heat: At the University of Chicago Medical Center, Scott Eggener uses a pinpoint laser to burn away cancerous cells.
In 2011, nearly 220,000 men in the United States will be diagnosed with cancer of the prostate, the golf-ball-size gland that makes the fluid that sends sperm on its way. Among this year’s victims: Steven Fisher, 60.
Fisher, a Chicago resident, didn’t want to become one of the 32,000 men in this country who die of the disease annually. But he was wary of undergoing traditional treatments, such as radiating the malignant cells or surgically removing the prostate, which, because the prostate is close to the bladder and the nerves that control erections, can lead to incontinence or impotence. He also felt uncomfortable with what’s called “watchful waiting” or “active surveillance”—essentially, doing nothing.
So, in late April, Fisher pursued another course, becoming the ninth patient at the University of Chicago Medical Center to participate in a clinical trial for focal laser ablation, a procedure that pairs magnetic resonance imaging (MRI) with a pinpoint laser to burn away a prostate’s cancerous cells. Scott Eggener, Fisher’s urologic oncologist and the leader of the trial, says that the technique—which he calls “the equivalent to women with breast cancer having a lumpectomy”—appears, so far at least, to meet the Hippocratic oath’s ideal of doing no harm. “The big question,” he says, “is whether it adequately kills cancer cells.”
For Fisher, doctors took MRI pictures of the prostate cancer and then (using conscious sedation for patient comfort) placed a perforated template against his perineum. After they pinpointed the exact location of the cancerous lesions, they inserted the tip of the laser through the proper hole in the template and destroyed the cancerous cells with high heat applied for between 30 seconds and two minutes. The entire procedure takes from 90 minutes to four hours, depending on the time spent finding the exact places to target. (Men with low-risk prostate cancer visible by MRI can sign up for the trial by calling 773-702-5195.) “Focal therapy ideally is a hybrid approach that takes the best elements of active surveillance and the best elements of radiation and surgery,” says Eggener. “This is at the very worst the same as surveillance. [Fisher] hasn’t lost any ground.”
The procedure did not impair Fisher’s urinary and sexual functions—and if follow-up MRIs and biopsies show that cancerous cells remain or have returned, he still has the option of having his prostate removed. “The study gave me the best of all possible worlds,” Fisher says. “This is hedging all my bets.”
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From one perspective, Fisher is a lucky man: He lives in a city where Eggener and other doctors are aggressively seeking ways to better detect and battle prostate cancer. William Catalona, a professor of urology at Northwestern University’s Feinberg School of Medicine (and the medical director of the Urological Research Foundation), developed the widely used prostate-specific antigen (PSA) test while at the Washington University School of Medicine in St. Louis. (The Food and Drug Administration approved the test in 1998.) When men score below 2 on the test, they can be fairly confident that they do not suffer prostate cancer; if they score 10 or more, they need to follow up with their doctor. The trick is knowing whether to go through the time and expense of biopsies for men who score between 2 and 10—what Catalona calls “the diagnostic gray zone.”
Photograph: Bob Stefko