Contemporary treatments in prostate cancer focal therapy

Abstract

Purpose: Radical treatments for prostate cancer are associated with significant morbidity, including incontinence and erectile dysfunction. Advances in the field of prostate MRI and desire to reduce treatment morbidities have led to a rapid growth in focal treatments for prostate cancer. Here, we review novel focal prostate cancer treatments and their associated recent clinical data, with a particular focus on data reported within the last 24 months. Recent findings: High Intensity Focal Ultrasound (HIFU), Focal Laser Ablation (FLA), Irreversible Electroporation (IRE), Focal Cryotherapy, and Photodynamic Therapy (PDT) have been used as treatment modalities for localized prostate cancer treatment. Despite the great variety of treatment techniques, each of these modalities is characterized by a significant rate of prostate cancer persistence within treatment zones (6–50%) and the presence of residual cancer within the prostate on re-biopsy (24–49%). These treatments, however, are associated with very low rates of high-grade complications, rare incontinence, and only mild or transient reductions in erectile function. The most common adverse events are urinary tract infections, hematuria, and urinary retention. Summary: Prostate cancer focal therapy is an attractive option for well selected patients due to its low complication profile, however long-term oncologic outcome is still lacking and early recurrence rates are high, limiting the ability of most urologic associations from endorsing its routine use.

The impact of the co-registration technique and analysis methodology in comparison studies between advanced imaging modalities and whole-mount-histology reference in primary prostate cancer

“…In recent years, positron emission tomography with prostate specific membrane antigen (PSMA)-labelled tracers has emerged as a useful technique for diagnostics and staging of primary and recurrent PCa 2 – 5 . Accurate identification and delineation of intraprostatic tumor lesions is particularly important for individualized focal therapy approaches such as focal dose escalated radiotherapy (RT) 6 , high intensity focused ultrasound or irreversible electroporation 7 . In order to evaluate and compare performance of mpMRI and PSMA-PET, our team and other workgroups conducted comparison studies using histopathology as standard of reference.…”

Intraindividual comparison between 68Ga-PSMA-PET/CT and mpMRI for intraprostatic tumor delineation in patients with primary prostate cancer: a retrospective analysis in 101 patients

“…Prostate cancer (PCa) is the most common tumor entity for men in North America [ 1 ] and Europe [ 2 ], and PCa incidence rates are rising steadily in Asian countries as well [ 3 ]. The accurate delineation of intraprostatic tumor burden is mandatory for successful fusion biopsy guidance [ 4 ] and for focal therapy planning such as focal dose escalation in radiotherapy (RT), high-intensity focused ultrasound (HIFU) focal laser ablation (FAL), cryotherapy, or irreversible electroporation (IRE) [ 5 ].…”

Nerve Growth Factor Induces Proliferation and Aggressiveness in Prostate Cancer Cells

“…This cancer is often characterized by a slow and symptom-free growth, and early-stage treatments include radical prostatectomy, novel androgen receptor (AR) pathway inhibitors, such as abiraterone and enzalutamide, external beam radiotherapy (RT), brachytherapy and cryotherapy [2,3]. Further, use of new tracers for Positron Emission Tomography/Computed Tomography (PET/TC) [4,5,6,7] and novel focal therapies [8,9] have provided important advances in diagnosis, follow-up and treatment of PC patients in the last decade.…”