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Of all the possible adjectives to describe prostate cancer, two of the most important ones are “bilateral” and “multifocal.” This is true even for a man lucky enough to be diagnosed with potentially insignificant cancer. Expectant management may be one good option (read story). But if the man opts for curative treatment, he ought to choose a treatment that eradicates all of the prostate. This, says Jonathan I. Epstein, M.D., would rule out one potential option: Cryosurgery — freezing the tumor — on just one part of the prostate.
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The idea there, called unilateral (treatment on just one side of the prostate) cryosurgery, is to treat minimally, just on the area that needs it. This would be “a focal treatment for prostate cancer that, on biopsy, is confined to one prostate lobe,” says Epstein. However, he cautions, “prostate cancer is generally not a focal, unilateral disease.” He should know; Epstein, the Rose-Lee and Keith Reinhard Professor of Urologic Pathology, has looked at thousands of prostate cancer specimens, and either of a higher grade, or bigger, in some cases extending beyond the prostate or to the surgical margins — than the cancer that had originally been found. “Urologists need to be informed and patients should be told the risks of leaving significant cancer behind prior to undergoing experimental focal therapy,” says Epstein.
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