Focal Therapy of Prostate Cancer

Nicolai Hübner; Shahrokh F. Shariat; Mesut Remzi


Curr Opin Urol. 2018;28(6):550-554. 

In This Article

Photodynamic Therapy

Photodynamic therapy (PDT) consists of an intravenous agent, which is subsequently activated by light to generate radical oxygens in the illuminated area, which in turn cause vascular necrosis.

Phase III data are available with 4 years of follow-up reported by Gill et al..[30] In this randomized controlled trial (RCT), 4013 men with low-risk PCa were randomized to receive either focal therapy with PCM301 (PDT) or active surveillance. PDT was associated with a significantly lower rate of cancer progression [hazard ratio 0.42, 95% confidence interval (95%CI) = 0.29–0.59, P < 0.001] and also a lower rate of conversion to radical therapy with 24 vs. 53% at 4 years (hazard ratio 0.31, 95% CI = 0.21–0.46, P < 0.001).[30] Functional outcomes were reported on the same study after 2 years of follow-up by Azzouzi et al. showing no significant difference in IPSS and IIEF-5 after 24months between the PDT and the active surveillance group (P = 0.64). Adverse events were higher in the PDT group, the most common of which were urinary tract infections and perineal pain. The latter occurred in 30 patients undergoing treatment and none for active surveillance.[31]

PDT is exclusive in that it has a phase III RCT showing safety, efficacy and decent oncologic outcome, yet it has only been used for low risk patients, with the active surveillance group showing a very high rate of progression. Also, patients must be protected from light during the procedure, and avoid direct sunlight for 48 h postoperatively to avoid further side effects. Further trials are currently ongoing including higher-grade tumours.