PURPOSE: Based on contemporary epidemiological and pathological characteristics of prostate cancer we explain the rationale for and concerns about focal therapy for low risk prostate cancer, review potential methods of delivery and propose study design parameters. MATERIALS AND METHODS: Articles regarding the epidemiology, diagnosis, imaging, treatment and pathology of localized prostate cancer were reviewed with a particular emphasis on technologies applicable for focal therapy, defined as targeted ablation of a limited area of the prostate expected to contain the dominant or only focus of cancer. A consensus summary was constructed by a multidisciplinary international task force of prostate cancer experts, forming the basis of the current review. RESULTS: In regions with a high prevalence of prostate specific antigen screening the over detection and subsequent overtreatment of prostate cancer is common. The incidence of unifocal cancers in radical prostatectomy specimens is 13% to 38%. In many others there is an index lesion with secondary foci containing pathological features similar to those found incidentally at autopsy. Because biopsy strategies and imaging techniques can provide more precise tumor localization and characterization, there is growing interest in focal therapy targeting unifocal or biologically unifocal tumors. The major arguments against focal therapy are multifocality, limited accuracy of staging, the unpredictable aggressiveness of secondary foci and the lack of established technology for focal ablation. Emerging technologies with the potential for focal therapy include high intensity focused ultrasound, cryotherapy, radio frequency ablation and photodynamic therapy. CONCLUSIONS: Early detection of prostate cancer has led to concerns that while many cancers now diagnosed pose too little a threat for radical therapy, many men are reluctant to accept watchful waiting or active surveillance. Several emerging technologies seem capable of focal destruction of prostate tissue with minimal morbidity. We encourage the investigation of focal therapy in select men with low risk prostate cancer in prospective clinical trials that carefully document safety, functional outcomes and cancer control.
PURPOSE: Based on contemporary epidemiological and pathological characteristics of prostate cancer we explain the rationale for and concerns about focal therapy for low risk prostate cancer, review potential methods of delivery and propose study design parameters. MATERIALS AND METHODS: Articles regarding the epidemiology, diagnosis, imaging, treatment and pathology of localized prostate cancer were reviewed with a particular emphasis on technologies applicable for focal therapy, defined as targeted ablation of a limited area of the prostate expected to contain the dominant or only focus of cancer. A consensus summary was constructed by a multidisciplinary international task force of prostate cancer experts, forming the basis of the current review. RESULTS: In regions with a high prevalence of prostate specific antigen screening the over detection and subsequent overtreatment of prostate cancer is common. The incidence of unifocal cancers in radical prostatectomy specimens is 13% to 38%. In many others there is an index lesion with secondary foci containing pathological features similar to those found incidentally at autopsy. Because biopsy strategies and imaging techniques can provide more precise tumor localization and characterization, there is growing interest in focal therapy targeting unifocal or biologically unifocal tumors. The major arguments against focal therapy are multifocality, limited accuracy of staging, the unpredictable aggressiveness of secondary foci and the lack of established technology for focal ablation. Emerging technologies with the potential for focal therapy include high intensity focused ultrasound, cryotherapy, radio frequency ablation and photodynamic therapy. CONCLUSIONS: Early detection of prostate cancer has led to concerns that while many cancers now diagnosed pose too little a threat for radical therapy, many men are reluctant to accept watchful waiting or active surveillance. Several emerging technologies seem capable of focal destruction of prostate tissue with minimal morbidity. We encourage the investigation of focal therapy in select men with low risk prostate cancer in prospective clinical trials that carefully document safety, functional outcomes and cancer control.
Authors: Hashim U Ahmed; Oguz Akin; Jonathan A Coleman; Sarah Crane; Mark Emberton; Larry Goldenberg; Hedvig Hricak; Mike W Kattan; John Kurhanewicz; Caroline M Moore; Chris Parker; Thomas J Polascik; Peter Scardino; Nicholas van As; Arnauld Villers Journal: BJU Int Date: 2011-11-11 Impact factor: 5.588
Authors: Scott E Eggener; Alex Mueller; Ryan K Berglund; Raj Ayyathurai; Cindy Soloway; Mark S Soloway; Robert Abouassaly; Eric A Klein; Steven J Jones; Chris Zappavigna; Larry Goldenberg; Peter T Scardino; James A Eastham; Bertrand Guillonneau Journal: J Urol Date: 2009-02-23 Impact factor: 7.450
Authors: Berrend G Muller; Jurgen J Fütterer; Rajan T Gupta; Aaron Katz; Alexander Kirkham; John Kurhanewicz; Judd W Moul; Peter A Pinto; Ardeshir R Rastinehad; Cary Robertson; Jean de la Rosette; Rafael Sanchez-Salas; J Stephen Jones; Osamu Ukimura; Sadhna Verma; Hessel Wijkstra; Michael Marberger Journal: BJU Int Date: 2013-11-13 Impact factor: 5.588
Authors: Satish Viswanath; Robert Toth; Mirabela Rusu; Dan Sperling; Herbert Lepor; Jurgen Futterer; Anant Madabhushi Journal: Proc SPIE Int Soc Opt Eng Date: 2013-03-15