Patients With Recurrent Prostate Cancer May Not Be Offered All Definitive Treatment Options

Florida urologist warns prostate cancer patients to learn all of their treatment options before making a choice.

Online PR News – 02-August-2010 – – Coral Springs, FL - August 2, 2010 – Renowned urologist Dr. Bert Vorstman urges prostate cancer patients and their spouses to learn about the four definitive treatment options for localized prostate cancer recurrence. He warns that they may not be given the most effective treatment options for recurrent disease, as some urologists are untrained about the benefits of minimally invasive options.

According to Dr. Vorstman, The four definitive options to treat localized prostate cancer recurrence are the same as those used to treat the disease initially. These are High Intensity Focused Ultrasound (HIFU), cryoablation (freezing), radiation and surgery. The survival benefits for all four are similar, but the first three carry fewer risks and therefore better quality of life (qol).

Of the three minimally invasive options, Dr. Vorstman recommends HIFU. When asked why, he stated, “HIFU is the most precise treatment option. Not only is it not a surgical treatment, but it also uses no radiation, and it can be repeated. HIFU can treat prostate cancer both at initial presentation and when recurrence is found. I prefer it over cryotherapy and radiation in most cases because the cancer tissue is expelled from the body during urination, rather than left inside after being frozen or after radiation treatment. The fact that the treated tissue is expelled after HIFU may minimize the chance of the tissue producing a recurrence later.”

With these benefits, it seems obvious that HIFU is the best option to treat prostate cancer recurrence for many patients. Yet most patients are not offered this as a treatment option. When asked why, Dr. Vorstman stated, “Sadly, few urologists are familiar with or have had the training necessary to perform minimally invasive therapies like HIFU or cryotherapy.”

After any treatment for prostate cancer, a patient’s doctor will track PSA numbers periodically to determine whether or not the cancer is recurring. In approximately 1/3 of all patients, the PSA will rise after a definitive treatment. This generally indicates a recurrence, even if the cancer is not detectable. When asked about this, Dr. Vorstman said, “For some patients, a rise in PSA without detectable cancer can mean a slow recurrence. For these men we recommend active surveillance. When the PSA doubling time is fast, we will biopsy the gland to determine if the cancer is growing again. If it is, we will discuss potential treatment options.”

Dr. Vorstman recommends that patients always have their biopsies read twice, once by the general pathologist and a second time at a reference laboratory to validate the finding. The course of treatment followed for recurring cancer depends on the first treatment pursued.

If a patient had radiation treatment initially, many doctors will use androgen deprivation therapy, or “hormone shots,” to treat a recurrence. Dr. Vorstman cautions against this option, as it has significant quality of life risks, including problems with metabolism and bone wasting issues. Instead, patients and their wives should consider HIFU or cryotherapy as an alternative treatment when radiation has failed.

Sometimes patients who opt for surgery, including robotics, initially think that their risk of recurrence is much lower, but according to Dr. Vorstman this is not the case. “Truthfully, 20 to 40 percent of men who have had surgery will have positive margins to their specimens. This means that prostate cancer was left behind. Usually, their surgeons will offer the hormone shots or radiation to the prostatic bed to treat this residual cancer. If there is a nodule in the prostatic bed that is definitely cancerous, we can also use HIFU to treat the cancer.”

About Dr. Vorstman

Dr. Bert Vorstman performed his chief residency at the University of Miami and completed a Fellowship in Pediatric and Adult Reconstructive Urology at the Eastern Virginia Medical School. A former assistant professor at the University of Miami, today Dr. Vorstman treats patients at Florida Urological Associates. He also writes and speaks on minimally invasive prostate cancer treatment options, with an emphasis on HIFU. For more information about HIFU or Dr. Vorstman, visit

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