Is Focal Therapy the Future for Prostate Cancer?

Hashim U Ahmed; Mark Emberton

Disclosures

Future Oncol. 2010;6(2):261-8. 

In This Article

Abstract and Introduction

Abstract

Focal therapy aims to find a middle ground between surveillance and radical therapies by treating the cancer alone, with a margin, and preserving as much tissue as is practical. Early feasibility studies have demonstrated an absence of rectal toxicity and preservation of genitourinary function in 80-90% of men. The incidence of low- to intermediate-risk prostate cancer is rising owing to informal and formal prostate-specific antigen screening practices. The treatment burden from radical therapies is high with over 50% of men suffering genitourinary or rectal toxicity. Active surveillance, on the other hand, carries surveillance and psychological burden with risk of progression. A research strategy to evaluate focal therapy should be embedded within pragmatic designs using a broad patient group, using the available ablative technologies (cryotherapy, high-intensity focused ultrasound, brachytherapy and photodynamic therapy) with end points derived from biochemical, biopsy and imaging. Within this framework there exists a unique opportunity to undertake landmark diagnostic studies incorporating imaging techniques and biomarkers in addition to studies directed at the biology of prostate cancer over time.

Introduction

Focal therapy has gained considerable interest over the last 5 years as a treatment paradigm that could offer the middle ground between surveillance and radical therapies.[1,2,3,4,5] Focal therapy aims to treat only the areas of cancer and preserve tissue in order to reduce the side effects associated with whole-gland radical therapies. With case series demonstrating encouraging side-effect profiles after focal therapy, namely up to 80-90% preservation of genitourinary function, a framework for further discussion and debate to guide the research strategy is required.

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