Urologic oncologist Scott Eggener
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


Now Catalona and his team have developed a new, more refined PSA test that can provide better risk information to these men. This test looks for a substance called minus-2 Pro PSA, which increases in the blood of patients who have prostate cancer—especially those who have the more aggressive forms of the disease.

Northwestern’s doctors are also studying why people living in Asia have much lower prostate cancer rates—and their findings are leading to a counterintuitive treatment. “When people have chemotherapy, the notion is you want to kill cancer cells,” says Catalona. Now researchers are looking at whether genistein, a chemical found in soy bushes—and in diets rich in soy—may shut down the genes that cause cancer cells to invade and spread. Similar to HIV medications, genistein neutralizes the bad cells rather than killing them—in the process, allowing men with prostate cancer to live longer. (Patients with high-risk prostate cancer can enroll in the program by calling 312-695-1995.)

Looking for more efficient ways of detecting returning cancers, another Northwestern urologist, C. Shad Thaxton, is crafting a nanotechnology test that senses tiny levels of PSA in the blood. Once perfected, the test would identify which cells could become cancerous, allowing doctors to initiate treatment earlier and possibly “improve the outcomes for patients with prostate cancer recurrence,” says Thaxton.

Other new high-tech treatments use surprisingly simple ideas. Take the collaborative trial conducted by the Rush University and University of Illinois Medical Centers. It uses high-intensity, highly focused ultrasound to zap specific spots where cancer lesions have recurred after radiation therapy. To explain the process, Leslie Deane, the director of laparoscopic, endourology, and robotic urologic surgery at the U. of I., uses the example of a familiar childhood activity. “As a kid,” he says, “you would sometimes play around with a magnifying glass, focusing the sun’s light on leaves, and you would see a burn.” (Radiation-therapy patients whose pros­tate cancer has returned can sign up for the new trial by calling 312-440-5127.)

Also at the U. of I., Gail Prins, an andrologist and professor of physiology, is studying how prostate cancers grow in rats. Specifically, she thinks bisphenol A (BPA), which is found in plastic bottles and other products, may harm prostate tissue in baby boys in the womb. When the prostate encounters this estrogen-like compound early in its development, it lays down marks on the DNA, perhaps with long-term repercussions. (Prins recommends steering clear of polycarbonate plastics with a 7 on the bottom and carbonless receipts, most of which contain BPA.)

Meanwhile, robotic surgery is no longer just the stuff of sci-fi movies. “It’s not like a robot assembling a car,” says Deane. Surgical robots allow for the use of other tools with unexpected “skills,” such as the ability to blow carbon dioxide gas into an abdomen to create a larger workspace and compress veins so they bleed less; they also make usually complex cases, such as treating a 350-pound patient, easier. Robots can magnify things 12 to 15 times their normal size, which means surgeons can more carefully control every move; what’s more, the incisions made are significantly smaller—often no bigger than half an inch (into which doctors insert their surgical tools)—and the operations themselves are less invasive. For example, with prostate surgery, patients end up spending only 24 hours in the hospital, not the two to five days typical for more traditional surgical methods.

“The advantages are much less pain and suffering,” says Arieh Shalhav, the chief of urology at the University of Chicago. “And the quality of surgery and continence and potency are as good or better”—helping to diminish the chief concerns of any man confronted with a scary diagnosis of prostate cancer.