BERKELEY, CA (UroToday.com) - In our recently published article, we presented an up-to-date review of the available literature on high-intensity focused ultrasound (HIFU) as a definitive treatment of prostate cancer. We presented the technique in a comprehensive approach in terms of technical features, procedure, and indications and provided an overview of its historical background; in addition, we aimed to predict HIFU’s future applications and its development trend.
To date, currently accepted therapies for patients with localized prostate cancer include surgery, radiation therapy, and brachytherapy. Other approaches include hormonal therapy and active surveillance. For surgery and radiotherapy, there have been technical developments during the last 10 years and long-term outcome data are available for both types of treatment to support their use in daily practice. Whatever the treatment method, the current treatment for organ-confined disease is radical, in which the whole prostate gland is treated, as well as the prostate cancer within it. Taking into account that prostate cancer may be multifocal in nature, detection of small foci of disease could result in a better “targeted therapy.”
Novel therapeutic methods have emerged in recent years as “focal” treatment alternatives in which cancer foci can be eradicated, avoiding whole-gland therapies with their inherent toxicity and damage risk to neighboring structures, thus reducing the associated side effects of radical treatment. HIFU seems to result in a well-fitted technology, which has proven short- to medium-term cancer control, with a low rate of complications comparable with those of longer-established therapies.
Following the guidelines of previous consensus meetings where issues related to case selection, conduct of therapy, and outcomes associated with focal therapy for localized prostate cancer were established, a multidisciplinary group of experts from North America and Europe met on several occasions (www.focaltherapy.org) to discuss tissue-preserving strategies of focal therapy. The Transatlantic group proposed that emerging diagnostic tools, e.g., precision imaging and transperineal prostate mapping biopsy, can improve prostate cancer care and should be integrated into prostate cancer management and research, thus establishing better risk stratification and more effective treatment allocation. They also suggested different study designs for future clinical trials in the assessment of focal therapy for prostate cancer, in matters of patient population, tools for risk stratification and cancer localization, treatment interventions, as well as comparators and outcome measures.
However, important questions remain regarding the best and the most reliable methods for predicting the target area for therapy. It is clear that the use of diagnostic imaging will play a larger role in patient selection, based on the design of several enrolling clinical trials. New promising techniques for localization and identification of prostate cancer based on ultrasound (US) and multiparametric magnetic resonance imaging (mpMRI) are in development. However, more research and comparative studies are needed before we can use them for focal therapy selection.
Meanwhile, HIFU seems to result in short- to medium-term cancer control, as shown by a high percentage of negative biopsies and decreased PSA levels, with a low rate of complications, comparable with those of established therapies. Nevertheless, longer-term follow-up studies are needed to evaluate cancer-specific and overall survival, preferably through RCTs comparing HIFU with standard care treatments and watchful waiting. In conclusion, if the available promising results on HIFU for definitive treatment of prostate cancer are confirmed in future prospective trials, focal therapy could start to challenge the current standard of care.
Written by:
Ernesto R. Cordeiro Feijoo, MD, Urologist as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
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High-intensity focused ultrasound (HIFU) for definitive treatment of prostate cancer - Abstract
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