MRI-Guided Therapeutic Procedures in Recurrent Prostate Cancer

Abstract

The American Cancer Society estimated that 217,730 new cases of prostate cancer would be diagnosed in the USA in 2010 (Jemal et al. in CA Cancer J Clin 60(5):277−300, 2010). Many men with prostate cancer are often treated with aggressive therapy, including radiotherapy, surgery, or androgen deprivation. No matter how expertly done, these therapies have significant risk and affect the patient’s health-related quality of life, with impact on sexual, urinary, and bowel function (Potosky et al. in J Natl Cancer Inst 96(18):1358−1367, ). Active screening programs for prostate cancer have identified increasing numbers of low-risk prostate cancer that have encouraged regimens of active surveillance to delay treatment until cancer progression (Jemal et al. in CA Cancer J Clin 56(2):106−130, 2006). Although active debate continues on the suitability of focal or regional therapy for these low-risk prostate cancer patients, many unresolved issues remain which complicate this management approach. Among them are prostate cancer multifocality, limitations of current biopsy strategies, suboptimal staging by accepted imaging modalities, and less than robust prediction models for indolent prostate cancers. In spite of these restrictions, focal therapy continues to confront the current paradigm of therapy for low-risk disease (Onik et al. in Urology 70(6 Suppl):16−21, ). When accurate staging and characterization of the risk posed by a particular prostate cancer is achieved, focal therapy will become a viable option for the management of prostate cancer.