Future perspective of focal therapy for localized prostate cancer

Abstract

Objective To summarize the recent literature discussing focal therapy for localized prostate cancer. Methods A thorough literature review was performed using PubMed to identify recent studies involving focal therapy for the treatment of localized prostate cancer. Results In an effort to decrease the morbidity associated with prostate cancer treatment, many urologists are turning to focal therapy as an alternative treatment option. With this approach, the cancer bearing portion of the prostate is targeted while leaving the benign tissue untouched. Multiparametric magnetic resonance imaging remains the gold standard for visualization during focal therapy, but new imaging modalities such as prostate specific membrane antigen/positron emission tomography and contrast enhanced ultrasound are being investigated. Furthermore, several biomarkers, such as prostate cancer antigen 3 and prostate health index, are used in conjunction with imaging to improve risk stratification prior to focal therapy. Lastly, there are several novel technologies such as nanoparticles and transurethral devices that are under investigation for use in focal therapy. Conclusion Focal therapy is proving to be a promising option for the treatment of localized prostate cancer. However, further study is needed to determine the true efficacy of these exciting new technologies.

Advantageous Detection of Significant Prostate Cancer Using a Low-Field, Office-Based MRI System

“…Further, the continued advance of efforts in the field of minimally invasive focal therapy increases the need for more precise cancer lesion identification and mapping [ 17 ]. These promising new focal therapeutic approaches such as selective cryoablation, high-intensity focused ultrasound, and other technologies add an important new consideration to the role of early detection and accurate imaging.…”

Clinical and pathologic characteristics to select patients for focal therapy or partial gland ablation of nonmetastatic prostate cancer

“…In this evolving paradigm, focal therapy is gaining popularity not just as an alternative to active surveillance, but, as an acceptable alternative to whole gland therapy in appropriate cases. Energy delivered during focal therapy leads to irreversible tissue damage in the intended focus and can be delivered by multiple modalities, cryotherapy, high-intensity focused ultrasound (HIFU), focal laser ablation (FLA), irreversible electroporation (IRE), targeted photodynamic therapy (PDT), focal brachytherapy (FBT), gold-silica nanoshells, transurethral ultrasound ablation, bipolar radiofrequency ablation (RFA), focal radiation therapy, microwave therapy or targeted cell perforating agents [6 ▪ ]. A recent survey found that though only a quarter of urologists utilised focal therapy in clinical practice, nearly half believed it to be moderate to extremely beneficial [4].…”