158 - Focal Therapy for Prostate Cancer

Abstract

Focal therapy offers a targeted, minimally invasive and function-preserving approach to treating prostate cancer. Although the majority of prostate cancer remains multifocal, disease progression is often driven by one dominant lesion, with most satellite lesions constituting indolent, low-grade cancer. In this vein, focal therapy can potentially extend the pool of active surveillance candidates in situations in which clinically significant cancer foci are focally targeted and eradicated, and residual clinically insignificant cancer can be monitored. Because of the constant evolution in technology, there is an expanding number of ablative energy sources (e.g., cryotherapy, high-intensity focused ultrasonography [HIFU], irreversible electroporation [IRE], laser therapy, vascular-targeted photodynamic [VTP] therapy, and brachytherapy) and multiple guidance systems (e.g., ultrasonography, multiparametric magnetic resonance imaging-ultrasound [mpMRI-US] fusion, in-bore magnetic resonance imaging [MRI]) available. Selection of technique depends on lesion location, operator expertise, and equipment availability. Patient selection and meticulous post-treatment monitoring are the tenets of a successful focal therapy strategy. Accurate mpMRI interpretation and effective targeted biopsy to identify offending foci and subsequent image-guided therapy require a multidisciplinary team of prostate cancer specialists. Although short-term data regarding focal therapy are promising, until long-term outcomes become available, this approach remains under investigation, and urologists should not hesitate to “convert” a patient to whole-gland treatment if the need arises. Adjuvant therapies under research appear to be promising and may further refine the outcomes of focal prostate therapy.