Leaving “the Las Vegas Effect” of conventional prostate cancer treatment

By Mary Lemma

By his own account, Dr. Al Barqawi is “a simple man.” But simple or not, he’s a man on the cutting edge of treating prostate cancer—without actually cutting anything.

In 2009, Barqawi adopted a technique he observed during treatment of a deep-brain tumor. If his colleague at the University of Colorado Hospital could “zap” the brain tumor without damaging nerves around the eye, he wondered why couldn’t the technique be applied as successfully to treat cancer of the prostate?

Dr. Al Barqawi, CU Cancer Center Urologist

Al Barqawi, MD, FRCS specializes in prostate cancer and minimally invasive surgery.

“It’s not rocket science,” Barqawi insists, yet the focal-laser treatment he has deployed on early-stage cancer patients relies on highly sophisticated 3D mapping technology to precisely locate the cancer. He then uses a laser to “fry” the tumor.

A pioneering surgeon with a ready metaphor, Barqawi sees focallaser treatment as a viable alternative to “the Las Vegas effect” of conventional approaches to prostate cancer, which will affect one man in six during his lifetime.

“With prostate cancer, there have been two options: overtreatment or undertreatment,” Barqawi says. Surgery is invasive and, while it may be the only known option for patients in advanced stages of the disease, there are side effects to consider: urinary complications, incontinence and erectile dysfunction—effects that also carry a psychological burden.

Barqawi says about two out of three men newly diagnosed with prostate cancer potentially fall into the “overtreatment” category. “For every 10 men who undergo radical treatment,” he says, “eight or nine didn’t need it to survive. A lot of people buy big cars when they don’t need them.”

And with watchful waiting, which ostensibly has no risk, you’re still risking undertreatment, he says.

“With either option, you’re gambling—and when you’re talking about cancer, ‘gambling’ is an ugly word,” he says. “Overtreatment and undertreatment are very prevalent, and our goal is to get out of this
cycle so we can improve the patient’s quality of life.”

The death rate from prostate cancer is going down and the disease is being discovered earlier, providing increased opportunity to use focal-laser therapy. Barqawi has successfully treated five prostate cancer patients since he began using the therapy in December 2009. Patients have been able to leave the hospital the same day they arrive, without side effects, drugs or catheters. Along with eliminating complications, focal-laser therapy costs less than the more common approaches to treating the disease.

Before hitting the cancer with a laser, Barqawi uses 3-D mapping to pinpoint it. (He and the application were featured in a Wall Street Journal article March 31, 2009.) “If I want you to arrest someone in the town where you live, but I don’t give you the address, you have to arrest the whole town. So 3D mapping, like MapQuest, makes so much sense,” he says. Barqawi has performed hundreds of biopsies using this minimally invasive approach.

The ideal candidate for focal-laser therapy, which surgeons at Duke, Harvard and Stanford are now following, is a patient like Duke Altschuler. Altschuler fit the common profile: His prostate specific antigen, or PSA, was elevated and he underwent a biopsy, indicating a very small area of the cancer.

Although Barqawi sounds like a man whose entire medical career has focused on managing or eradicating prostate cancer, he hasn’t always been a urologist. A former breast cancer surgeon, he saw opportunities to vastly improve the treatment and management of this most commonly diagnosed disease in men, to catch up with progress being made in the diagnosis and treatment other cancers.

One thing hasn’t changed, though: For clinical care providers such as Dr. Al Barqawi, it all comes down to this: “How can we do better for our patients? Here at the Cancer Center, we are solving problems.”