Abstract
In prostate cancer, an interesting and intriguing option to overcome the risks of whole-gland treatment is focal therapy, with the aim of eradicating known cancer foci and reducing collateral damages to the structures essential for maintaining normal urinary and sexual function. Ablation of all known lesions would favorably alter the natural history of the cancer without impacting health-related quality of life and allows for safe retreatment with repeated focal therapy or whole-gland approaches if necessary. Our objective is to reassess the possibilities and criticisms of such procedure: the rationale for focal therapy and the enthusiasm come from the success of conservative approaches in treating other malignancies and in the high incidence of overtreatment introduced by prostate cancer screening programs. One of the challenges in applying such an approach to the treatment of prostate cancer is the multifocal nature of the disease and current difficulties in accurate tumor mapmaking.
Highlights
Prostate cancer PC remains the most common, noncutaneous male malignancy, with an estimated 186,320 new cases diagnosed in 2008 in the United States [1]
Primary reports for accuracy of endorectal MRI prostate cancer staging show sensitivity up to 85%; one of the limitations of MRI is the difficulty of diagnosing central cancer, due to overlapping benign prostatic hyperplasia
Organ-sparing focal therapy may fill the gap between an active surveillance strategy and whole-gland treatmentproviding a reasonable balance between cancer control and QoL issues in the future [92]
Summary
Prostate cancer PC remains the most common, noncutaneous male malignancy, with an estimated 186,320 new cases diagnosed in 2008 in the United States [1]. The controversy on the benefit of PSA screening, as well as the known side effects of screening itself, served to highlight the concerns about overdetection and consequent overtreatment of patients who fall in the category of the socalled low-risk prostate cancer [4,5,6]. Current treatment of choice for men with localized prostate cancer lies between active surveillance and radical therapy. Active surveillance, being a “do-nothing” approach, carries the psychological burden of allowing a known cancer to adversely affect quality of life
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