My father died of cancer just before I turned 13 and he wasn't sick very long, over the course of a year or so he had a port installed, had a roughly horseshoe shaped and size scar on his scalp, had headgear bolted into his skull in multiple locations and the day we had to take him to the ER he had worked all day and by that night was effectively drowning in is own bodily fluids with his lungs mostly full of fluid at which point he went on a respirator, went unconscious and was taken off life support less than a week later.

Cancer sucks man, I'm sorry you got dealt that hand.

That said, many cases are life threatening.

I haven't read this paper, and it's been years since my Masters when I last kept up with this, but the patients at this stage are usually getting their prostates removed. The aggressiveness of the cancer is enough to threaten their life and well-being, so they elect for this procedure. It's usually followed up with radiation and chemotherapy to kill any residual tumour cells left behind, usually at the periphery, or if metastasis has occurred.

So great, prostate and cancer's gone, everyone's happy right? Well, no. The surgery damages a lot of the surrounding tissues, so these men are left with sexual dysfunction (which sucks but you can somewhat handle since you are living) and incontinence. The urinary and bowel issues affect your quality of life immensely. If you're in your 60s, you might have another 10-20 years to live with this. But if you're in your 40s, which is a lot of the cases for aggressive cancer types, you're stuck this way for many decades.

Hence why this ultrasound technique is so appealing because you can perform a minimally-invasive procedure that destroys only what you target, and spares the urethra and other tissues. Better outcomes, and better quality of life.

Given that the gold standard is surgery, this new technique has to prove itself against that, by showing that it is actually successfully destroying the cancer. That's why these clinical trials are occurring.

As an addendum, one study in Thailand looked at a sample size of dead men, and found that 1 in 7 had prostate cancer, but died of other causes. What that means is that many men get prostate cancer and may be asymptomatic because it is not aggressive. It can manifest as localized tumours/nodules within the prostate that you wouldn't be able to detect without good palpation and/or sensitive imaging. And because you're asymptomatic, you might not even seek diagnosis, and you'll probably die of other causes.

It also means that many men get diagnosed with cancer and may seek premature treatment. Most good doctors will recommend a watchful waiting approach; regular checkups and PSA level checks to ensure that you're still in the asymptomatic area. There's other treatments that can occur before surgery. But if you end up down this path, your cancer could be very localized within the prostate.

However, surgery is an all-or-nothing approach, there's no saving the prostate. Ultrasound ablation could be a good alternative and allow targeting. We're still far off from proving that though, but it's definitely viable. It's also why ultrasound ablation is being used for things like uterine fibroids, and breast cancer. There's even use cases for brain cancers.

It's a very cool technology, and I'm very optimistic for it. But I left my Masters in 2012, and we're still conducting these clinical trials. This is exactly the pace it should be occurring at, since it needs to be ironclad. But I found it too slow for my liking, so I moved on in my career path.

I'm wondering if it's just that the tool scrapes it out or something. As painful as it is to think about.