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Management of Prostate Cancer pp 225–241Cite as

Focal Therapy: Prostate Hemiablation as the First Historical Treatment Model for Focal Therapy of Early Stage Prostate Cancer

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Part of the book series: Current Clinical Urology ((CCU))

Abstract

We performed a comprehensive literature review to establish the current level of knowledge regarding the foundation for prostate hemi-ablation as the first feasible, focal therapy model. Recent data have demonstrated a significant pathologic stage migration towards earlier stage disease comprising unilateral pT2a/b prostate cancer (PCa). The cancer volume of the clinically significant tumor (represented by the index lesion) has been proposed as a driving force of PCa progression and therefore should be identified and treated at an early stage. When cancer is multifocal, it is now hypothesized that the majority of satellite lesions may not be life threatening to the patient. Other pathologic features such as Gleason score, extra-prostatic extension, and the spatial distribution of PCa within the prostate remain important facets as focal therapy selection criteria. Based on the current understanding of tumor biology of early stage disease and promising outcomes of the first single- and two-institution trials, a fundamental background for hemi-ablation of early stage PCa has been created. While the preoperative identification of a unifocal lesion or unilateral cancer remains challenging, the detection of unilateral lesions with subsequent hemi-ablative therapy of the prostate is a feasible undertaking at present.

This chapter summarizes the current data that provides the foundation for hemi-ablation as the first conceptual and feasible focal therapy modality that may facilitate the implementation of this novel treatment option into clinical practice. Using thousands of radical prostatectomy specimens with validated final pathologic data as a historical control, we are able to analyze the basic pathologic and clinical parameters in order to improve our understanding of early stage PCa to enhance proper candidate selection and acceptable treatment outcomes for hemi-ablation.

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Authors and Affiliations

  1. Department of Surgery and Urology, Duke University, Erwin Road, Durham, NC, 27710, USA

    Vladimir Mouraviev & Thomas J. Polascik

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  1. Vladimir Mouraviev
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  2. Thomas J. Polascik
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Correspondence to Thomas J. Polascik .

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Editors and Affiliations

  1. , Glickman Urological and Kidney, Cleveland Clinic, 9500 Euclid Ave, Cleveland, 44195, Ohio, USA

    Eric A. Klein

  2. Cleveland Clinic, Cleveland Clinic Lerner College of Medic, Department of Regional Urology, at Case Western Reserve, Cleveland, 44195, Ohio, USA

    J. Stephen Jones

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Mouraviev, V., Polascik, T.J. (2012). Focal Therapy: Prostate Hemiablation as the First Historical Treatment Model for Focal Therapy of Early Stage Prostate Cancer. In: Klein, E., Jones, J. (eds) Management of Prostate Cancer. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-259-9_14

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  • DOI: https://doi.org/10.1007/978-1-60761-259-9_14

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