The prostate cancer focal therapy

Abstract

Despite prostate cancer (PCa) is the leading form of non-cutaneous cancer in men, most patients with PCa die with disease rather than of the disease. Therefore, the risk of overtreatment should be considered by clinicians who have to distinguish between patients with high risk PCa (who would benefit from radical treatment) and patients who may be managed more conservatively, such as through active surveillance or emerging focal therapy (FT). The aim of FT is to eradicate clinically significant disease while protecting key genito-urinary structures and function from injury. While effectiveness studies comparing FT with conventional care options are still lacking, the rationale supporting FT relies on evidence-based advances such as the understanding of the index lesion's central role in the natural history of the PCa and the improvement of multiparametric magnetic resonance imaging (mpMRI) in the detection and risk stratification of PCa. In this literature review, we want to highlight the rationale for FT in PCa management and the current evidence on patient eligibility. Furthermore, we summarize the best imaging modalities to localize the target lesion, describe the current FT techniques in PCa, provide an update on their oncological outcomes and highlight trends for future research.

A pilot study of the shapes of ablation lesions in the canine prostate by laser, radiofrequency and microwave and their clinical significance

“…During the ablation process, adjacent organs and structures, including the urethra, bladder and rectum, could be affected and injured. Urinary retention, urinary incontinence, recto-urethral fistula, urethral strictures and erectile dysfunction may occur after ablation in short or long period [25,26]. According to the focal LA of prostate cancer in phase I and II trials, the most common complications include haematuria, perineal ecchymosis or abrasion, glans paraesthesia, acute urinary incontinence and sexual dysfunction [27,28].…”

Tracked Foley catheter for motion compensation during fusion image-guided prostate procedures: a phantom study

“…The TFC core concept of active intra-procedural fusion image correction may potentially be applied to other procedures, settings, or organs with additional hardware components and software [18]. The TFC ability to maintain accurate image alignment after motion could not only benefit existing procedures using fusion imaging (FBx, trans-perineal FBx, focal PCa ablations), but also potentially enable fusion guidance within robotic platforms [8,12,15,16,[19][20][21][22][23][24][29][30][31]. In addition to aid in alignment after simulated prostate motion, this study also indicated that the TFC may aid in more accurate image alignment while the patient remains static.…”

“…Moreover, computer-assisted biopsy systems may facilitate more widespread and standardised use of FBx, even by novice operators who may be uncomfortable manipulating dedicated navigation software [25,32]. On the other hand, some intrinsic limitations are still present such as the general contraindications for MRI (e.g., the claustrophobia and the presence of a magnetic field or of the pacemakers) and the current failure rate of TRUS-guided biopsy [12,[33][34][35][36]. Additional research may explore the extent to which the TFC aids in fusion image alignment when the prostate is static, specifically among novice FBx users.…”

“…FBx highlights the benefits that fusionguided procedures may offer patients; however, challenges and limitations remain. Currently, outcomes for image-guided prostate biopsy and focal ablation are highly dependent upon accurate needle placement at an exact target location [7,8,[10][11][12][13][14]. Semi-automated computer navigation and guidance allow for the registration (alignment/matching) of pre-procedural imaging (i.e, mpMRI) with real-time intra-procedural imaging (i.e, US).…”

Interventional radiology of glands

“…Recently, a lot of new IR procedures are being applied to prostate gland from invasive diagnosis to treatment of benign and malign diseases (6)(7)(8).…”