Laser that kills prostate cancer and spares your love life
AROUND 40,000 men are diagnosed with prostate cancer each year. Gerald Capon, 69, a lawyer from Felbridge, West Sussex, underwent a new treatment for the condition, as he tells LUCY HOLDEN.
THE PATIENT
Since i was about 40, i’ve visited my GP every two years under the ‘well man clinic’ scheme, which offers various medical checks. i had regular tests for blood pressure and cholesterol and, when i turned 60, i asked for a PSA — this is a blood test to measure the amount of prostate-specific antigen, a protein produced by cells in the prostate gland, which can indicate your prostate health.
in January 2011, doctors revealed the amount of PSA in my blood was slightly higher than it should have been.
My GP suggested i go on active surveillance — where the situation is monitored — and come back in six months for another test.
Unfortunately, during this time, the PSA reading had shot up to about three times as much as it should have been for someone my age.
i was immediately referred to a specialist urologist at Queen Victoria hospital in east Grinstead, West Sussex, for a rectal examination and MRi scan, followed by biopsies (where a tissue sample is taken and sent for analysis). The results revealed cancer in both sides of my prostate.
i was told i could stay on active surveillance because the cancer was at a very early stage and might not progress during my lifetime. But i didn’t want to do that.
i have a friend whose brother has prostate cancer and it got into his bones and there’s almost nothing they can do for him now.
Plus, when you hear the word cancer, you want to do something about it.
i was talked through various treatment options, such as having the whole prostate gland removed or sound waves or radioactive seeds inserted that would attack the cancer cells.
But many of the treatments seemed to carry the risk of incontinence and impotence or meant using a catheter for months.
As i do a lot of rambling and gardening, and i have four grandchildren and two daughters, i wanted to remain active.
i was then told i might be eligible for a trial of Tookad, a new drug that kills cancer cells when it’s activated by laser light shone on the prostate.
it has a quick recovery rate, which means you only have to wear a catheter overnight. it also has a much lower risk of erectile dysfunction and incontinence, i was told. i thought it sounded much better and my wife, Valerie, was 100 per cent behind me.
i had the op in the summer of 2011 under general anaesthetic.
The procedure involved doctors injecting me with a photosensitive drug and then shining a laser light on my prostate for 20 minutes. The light reached my prostate via tiny optic fibres that were inserted into it through the perineum — the skin between the legs.
i went home the next day feeling slightly sore, and took paracetamol daily for three to four weeks for the pain, but i could walk.
Because the cancer was on either side of my prostate, i had to have two sessions. i went back six months later for the second one. During that time, tests showed the first bout of treatment had worked.
When the time came for round two, in December 2012, the procedure went even better than the first one.
By new Year i felt fine. Straight after the treatment, i had blood tests, plus MRi scans every two to three months at UcL. everything has come back clear. now i just need to see my GP every six months for PSA tests. Looking back, i know i did the right thing in opting for this treatment.
i’ve no doubt it should be made available to everyone because i’ve had no side-effects and have spoken to lots of men who have had them from other treatments.
They shouldn’t have to deal with incontinence and impotence when there are therapies like this.
THE SURGEON
Mark eMberTon is a professor of interventional oncology at University College London and a consultant neurologist at University College hospitals nhS Foundation Trust. SURGeRY is the most common treatment for prostate cancer — where the walnut-sized gland is removed in its entirety. But this can cause impotence, damage to the rectum and incontinence.
Radiotherapy and chemotherapy can be effective, but can also lead to impotence by weakening the nerves and blood vessels that help a man get an erection.
Sexual function is at the forefront of men’s minds when they are considering whether to have surgery because it will change their lives for ever.
Many men are not able to get an erection while recovering after surgery and some lose the ability permanently. Laser therapy results in few side-effects. it targets prostate cancer with bursts of laser light and could eradicate tumours in thousands of men.
The technique involves a lightsensitive chemical (called WST11) that is activated by the laser light when it reaches cancer cells.
This chemical then releases destructive free-radical molecules that can kill cancerous cells by starving the tumour of oxygen.
Gerald was eligible for the trial we ran in 2011 because his cancer was spotted early on.
The results of that trial were published last week. And though the treatment isn’t yet available to other men, we hope it might be in the future.
in the trial, nearly half of the men with early-stage prostate cancer saw their tumour destroyed by the technique. There were no signs of disease two years later compared with just 13.5 per cent of patients who are cancer-free two years after standard treatment.
Of 400 patients, only one had side-effects (a previous prostate op may have been to blame).
Our technique could spare many patients the trauma of surgery or radiotherapy and the side-effects.
it really is a huge breakthrough for prostate cancer treatment, which has previously lagged decades behind other solid cancer treatments, such as those for breast cancer.
The procedure involves giving the patient a local anaesthetic between the legs.
next, we inject the drug into the bloodstream, which takes ten minutes, then we shine the laser light onto the prostate.
The effect of the laser light causes what is essentially intense sunburn to the prostate because it has been sensitised by the drug (giving it the quality of very pale skin under a hot sun).
When the photosensitiser comes into contact with light, a chemical reaction happens and the drug releases free radicals — molecules that we ordinarily try to avoid by eating healthily — directly into the vessels around the tumour.
This starves the oxygen supply to the cancer cells, killing them.
Because the tissue is destroyed in a controlled manner, damage to the surrounding healthy tissue is minimised — which means that incontinence and impotence are extremely rare side-effects.
it was very effective with Gerald and would be a good option for anyone whose cancer is at an early stage and localised to one part of the prostate (though Gerald’s wasn’t and we could still treat him by offering two sessions).
The treatment could become available on the nhS in a couple of years and patients could leave the hospital on the same day.