New Prostate Cancer Treatment

The June issue of Life Extension reviewed a new prostate cancer treatment. Prostate cancer affects about 180,000 men per year and 28,000 die every year from prostate cancer metastases. Dr. Gary Onik, interventional radiologist in Ft. Lauderdale, FL, developed a new prostate cancer treatment protocol. Two years ago he published a medical paper regarding a group of 70 prostate cancer patients following his treatment 10 years after their surgery.

New prostate cancer treatment protocol

Usually it is a rising prostate specific antigen test (PSA) that tells the treating physician that not all is well with the patient’s prostate gland. In the last two years a new more specific and very sensitive genetic screening test has been developed, called Oncoblot test. If this is positive for prostate cancer, it is almost as good as a prostate biopsy that shows the cancer cells directly. But at this point the medical profession does not accept the Oncoblot test as being proven reliable.

3-dimensional mapping biopsy replaces gold standard

A transrectal prostate biopsy was the “gold standard” for the last several decades. However, 14 years back Dr. Onik decided to develop a more meaningful and more reliable prostate mapping biopsy. With this 3-dimensional mapping biopsy the examiner inserts many biopsy needles through the perineum, the skin between the base of the scrotum and the anus. The physician records the location of the needles carefully and sends the biopsy samples to the pathologist for histological analysis. When the results come back, he records the biopsy results as a 3-dimensional image of the prostate cancer on a computer screen. This becomes the basis for the next step in the treatment protocol.

Cryotherapy replaces robotic prostatectomy 

The surgeon introduces cooling probes through the perineum and places them exactly to the cancer location from the prior prostate mapping. It is this closely controlled placement of the treatment probes that ensures a much higher treatment success rate compared to the “gold standard” of the robotic prostatectomy (removal of the prostate gland).

PSA helps to spot recurrent prostate cancer

The physician follows his patient with PSA blood tests at 3-monthly intervals until the level is low and stable. Should there be any rise in PSA the patient undergoes another prostate mapping biopsy. The surgeon may have to repeat the cryoablation therapy until the PSA is low or negative again.

10-year follow-up of 70 men with prostate ablation therapy

Dr. Onik followed 70 prostate cancer patients using the above protocol for a total of 10 years. The patient’s age was between 45 and 77 years at he time of surgery. 66 of Dr. Onik’s patients survived until the end of 10 years. The four who passed away, died of causes other than prostate cancer making the “disease-specific” survival rate 100%. PSA stability occurred in 89% of the patients.

High risk and low risk survival data with new prostate cancer treatment

Prostate cancer patients can be classified into high-risk, medium-risk and low-risk. It is a composite score from the histological characteristics of the cancer, the Gleason score (a measure of how aggressive the cancer is), the stage (based on the extend of the cancer) and the height of the PSA level.

Using conventional treatment (prostatectomy) long-term follow-up data show that low-risk patients have a disease free survival of 85%, while high-risk prostate cancer patients have a success rate of only 45%.

In contrast to this Dr. Onik’s protocol achieved a biochemical disease-free survival of 90% for low-risk patients, 88% for medium-risk patients and 89% for high-risk patients. Surprisingly there seems to be no difference with regard to the long-term outcome of any of the risk levels. This is unique for the Onik method of focal cryoablation therapy.

What is focal cryoablation therapy, the new prostate cancer treatment?

The prostate cancer is frozen much like a wart is frozen by liquid nitrogen treatment in the doctor’s office. In the case of prostate cancer ablation liquid Argon is used for freezing. The physician controls the temperature of the application closely using heat probes to ensure adequate freezing. The surgeon introduces the special cooling probes to the cancer areas as per the prostate mapping procedure. He does the freeze/thawing three times. This way he achieves a 100% kill of all of the cancer cells at the time of the procedure. The surgeon individualizes the  treatment for every patient according to his condition.

Comparison of focal ablation treatment with traditional prostatectomy

After 5 years of prostate mapping biopsies Dr. Onik published a study where he looked at 180 men who had been diagnosed with prostate cancer on one side of the prostate gland by standard rectal biopsies. When he did mapping biopsies involving the whole prostate gland he noticed the following:

  • 61.1 % (110 patients) had cancer on both sides of the prostate
  • 22.7 % (41 patients) who had been classified having a cancer with a low-grade score increased to an intermediate-grade score
  • 19.4 % (35 patients) had cancer growth in very close proximity to either nerve bundles or blood vessels.

69.4% of those patients who had been diagnosed as having only low-grade, one-sided tumors were found to have more extensive cancers. With the previous classification they were thought to need only active surveillance (also known as “watchful waiting”).

3-dimensional mapping biopsies have a greater resolution than blind rectal biopsies

But with the detailed mapping biopsy results things looked different. They had at least one finding that reclassified their disease to requiring a more aggressive cancer treatment protocol. Other physicians have found the same thing when looking at these patients with more sensitive MRI scans. The prostate cancers were more extensive than when depicted with simple MRI scans. In some patients where areas on one side of the prostate seemed free of cancer using traditional MRI’s, now showed cancer on both sides using the more sensitive MRI scanners. Also using blind rectal biopsies, which is the standard technique that most radiologists use, can often miss prostate cancers that are found with sensitive MRI scanners or Dr. Onik’s mapping biopsy.

Complication rate with new prostate cancer treatment

Very low recurrence rate following ablation cryotherapy

The recurrence rate of prostate cancer treated with cryotherapy ablation therapy after 10 years was only 4%. Compare this to a study where prostate cancer was treated with radiotherapy. After 10 years the biochemical disease free survival for low risk patients was 78%, for medium risk 78% and for high risk 62%. This translates into cancer recurrences of between 22% and 38% depending on the risk stratification. The so-called golden standard procedure (robotic prostatectomy) showed the following: in a study that went on for 5 years there was a 28% overall recurrence rate. When the margins of the prostatectomy were examined, the following amounts of cancer had remained: 23% for low risk patients, 29% for medium risks and 42% for high risks.

No urinary incontinence

Urinary continence was maintained in 100% of the cases meaning that the nerves going through the prostate gland were preserved.

Low rate of sexual problems after 10 years

Only 6% of patients treated with ablation therapy had problems with sex 10 years after the procedure. This compares favorably with the other treatment modalities that have much higher rates of sexual problems.

Overall patients tolerate cryoablation therapy very well and the procedure removes tumor tissue exactly where the 3-D mapping biopsy findings showed the prostate cancer  location. This helps the patients’ survival rates.

Conventional treatment failures versus the new prostate cancer treatment

What are the reasons for treatment failures with conventional prostate cancer?

Blind prostate cancer biopsies are generally trans-rectal procedures. They lead to infections of the prostate, in rare cases even to blood poisoning (septicemia), but they often miss cancers that mapping biopsies detect. Rectal biopsies require only 8 to 16 biopsies. They are blind, the physician does not know exactly where the biopsies came from. In contrast, the doctor keeps track carefully with mapping biopsies where the biopsies originated from. The doctor also sends them separately to the pathologist. With the mapping biopsy 60 to 90 biopsies are taken depending on the size of the prostate gland. There is a much higher resolution of the area where the prostate cancer is located. This helps the physician where to focus the cryoablation treatment.

Poor diagnostic tests lead to poor outcomes with conventional prostatectomy

Poor diagnostic tests prior to cancer surgery lead to missed prostate cancer removal, which in turn lead to recurrences. With a “Total prostatectomy” (robotic prostatectomy) the physician removes only 70% of the prostatic tissue. This leaves chunks of prostatic tissue behind. This is the reason why undiagnosed prostate cancer can regrow. This explains the poor 5-year follow-up results of 23% to 42% recurrence rates after the “gold standard prostatectomy”.

Mapping biopsy depicts the entire prostate gland

Only the mapping biopsy that depicts the entire prostate gland (the physician does it with the perineally approach to prevent infection) can show exactly the cancer location. The subsequent surgery consists of the removal of the cancer in its entirety.

Immune stimulation with cryoablation therapy

The cryoablation therapy is likely stimulating the immune system to send killer T cells to help with the destruction of any remaining cancer cells. This may partially explain the low 10-year recurrence rate of only 4%.

New Prostate Cancer Treatment

New Prostate Cancer Treatment


Dr. Onik, an interventional radiologist from Ft. Lauderdale, FL, has developed a new focal ablative prostate cancer treatment. He showed in a study going on for 10 years that it is superior to either radiotherapy or robotic prostatectomy. Baby boomers are aging and prostate cancer is a disease of aging men. This new treatment modality  arrived just in time to help men with the diagnosis of prostate cancer. Physicians expect their patients to have prostate cancer when their PSA value rises above 4 or 5. Instead of taking a risk of blood poisoning with E. coli or developing prostatitis from the transrectal biopsy approach, the patient may want to consider having the 3-dimensional mapping biopsy done by Dr. Onik in Ft. Lauderdale.

Perineal approach with cryotherapy for prostate cancer

The surgeon does the procedure through the perineal approach, which shows the exact location of the cancer. This method uses cryotherapy probes with liquid Argon to treat the cancer is focally. This is similar to a lumpectomy in a woman with early breast cancer. Cancer recurrence rates at 10 years were only 4%. The good news is that the surgeon can repeat a mapping biopsy of the prostate, if rising PSA levels should occur in the future. This shows whether there is a cancer recurrence, and this can be treated again with cryotherapy. Very likely more physicians will embrace this method in the future, as several centers are in the planning stage in the United States. They will very likely replace a “gold standard” of prostate cancer treatment that is less than perfect.