BERKELEY, CA (UroToday.com) - In recent decades there has been a trend toward an earlier diagnosis of prostate cancer (PCa), likely as a result of the adoption of screening strategies. This has led to greater identification of early-stage tumors.
Global therapies (radical prostatectomy, radiotherapy, brachytherapy) are currently the standard treatment for patients with localized PCa, with good oncological results. However, they have some drawbacks, such as a high incidence of adverse reactions that impair the quality of life. They may represent excessive treatment in low-risk groups as well as in and some intermediate cases. Although no focal therapy is currently the standard treatment of localized PCa, it represents the therapeutic approach with the most potential as far as future treatment strategies are concerned.
Upon choosing a focal therapy, three essential steps must be taken into consideration: 1) planning; 2) treatment; 3) and the control.
Planning is done by correctly selecting the candidates who could benefit from focal therapy. Currently there is no consensus on the selection criteria. It appears that the low volume unilateral PCa in patients at low risk (and at some intermediate case) is the most suitable for focal therapy inclusion. Therefore an accurate diagnosis is critical. New imaging techniques and biopsy have improved characterization of CaP, pretreatment, however, development and corroboration of such techniques is necessary.
Treatment should be individualized for each patient and should take into account the limitations of each type of energy. So far the thermal option is best explored. Selective application is complex due to the neighboring organs and organ perfusion. In this sense, the new non-thermal ablative therapies are promising.
Finally, subsequent control is nuanced treatment compared to patients treated with standard therapies. PSA can be evaluated using the principles of ASTRO, in which a PSA of 2 ng/ml from nadir is positive (some authors state that threshold to be at 1 ng/ml). In addition it is always necessary to perform a biopsy of control. This biopsy should be mapped by transperineal template with new systems that detect suspicious areas with TRUS or MRI, as are already being employed by experienced centers.
Most studies of focal therapy in PCa focus around cryotherapy and HIFU. Cryotherapy is currently considered an alternative treatment for localized PCa according EAU and AUA. HIFU, TFD, FLA are still considered experimental treatments. Multiple studies show that focal therapy is a minimally invasive treatment option with acceptable oncologic results and probably lower morbidity compared to the broad spectrum of treatments. Ultimately, the development of studies of high scientific evidence are required to validate these results.
Written by:
Fernando Xavier Jácome-Pita 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.
Urology Department, Fundación Jiménez Díaz, Madrid 28040, Spain
Focal therapy in prostate cancer: The current situation - Abstract