Abstract
New surgical techniques are continuously being developed in the field of prostate cancer, more so with the ever-increasing interest in minimally invasive techniques to treat solid organ cancers. This has been triggered by the current state of play with treating a disease that has a long natural history in which the benefits and risks of radical therapy are not quite right. In other words, whole-gland radical therapy or radiotherapy can cause significant complications that are a direct result of damage to surrounding structures, including erectile dysfunction (30–70 %), urinary incontinence (5–20 %) and bowel toxicity (5–10 %). Focal therapy aims to reduce the complication profile by focusing the therapy to the cancer lesion and preserving surrounding tissues, thus improving functional outcome.
Improvements in understanding about the biology of prostate cancer as well as huge strides in functional imaging and image-guided biopsy techniques have given rise to more accurate localisation and characterisation of prostate cancer lesions. This has led to a paradigm shift in prostate cancer treatment towards tissue-preserving focal approaches using high-intensity focused ultrasound, electroporation and photodynamic therapy. Focal therapy involves treating just the areas of prostate harbouring cancer and, by doing so, minimising the damage caused to collateral structures such as neurovascular bundles, external urinary sphincter, bladder neck and rectum.
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References
Sanda MG, Dunn RL, Beyth RJ, Neuberger MM, et al. Screening for prostate cancer: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2010;341:c4543.
Wilt TJ, MacDonald R, Rutks I, et al. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. 2008;148:435–48.
Ohori M. Multiple cancers in the prostate. Morphologic features of clinically recognized vs incidental tumours. Cancer. 1992;70:2312–8.
Karavitakis M. Tumour focality in prostate cancer: implications for focal therapy. Nat Rec Clin Oncol. 2011;8(1):223–7.
Furusato B, Gao CL, Ravindranath L, et al. Mapping of TMPRSS2-ERG fusions in the context of multi-focal prostate cancer. Mod Pathol. 2008;21:67–75.
Wise AM, Stamey TA, McNeal JE, Clayton JL. Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. Urology. 2002;60:264–9.
Wolters T, Roobol MJ, van Leeuwen PJ, et al. A critical analysis of the tumor volume threshold for clinically insignificant prostate cancer using a data set of a randomized screening trial. J Urol. 2011;185:121–5.
Van der Kwast TH. The trade-off between sensitivity and specificity of clinical protocols for identification of insignificant prostate cancer. Eur Urol. 2012;62:469–71.
Fuchsjager MH, Pucar D, Zelefsky MJ, et al. Predicting post-external beam radiation therapy PSA relapse of prostate cancer using pretreatment MRI. Int J Radiat Oncol Biol Phys. 2010;78:743–50.
Ahmed HU, Arya M, Freeman A, Emberton M. Do low-grade and low-volume prostate cancers bear the hallmarks of malignancy? Lancet Oncol. 2012;13(11):e509–17. doi:10.1016/S1470-2045(12)70388-1.
Tsakiris P, Thüroff S, de la Rosette J, Chaussy C. Transrectal high-intensity focused ultrasound devices: a critical appraisal of the available evidence. J Endourol. 2008;22(2):221–9.
Ahmed HU, Freeman A, Kirkham A, Sahu M, Scott R, Allen C, Can der Meulen J, Emberton M. Focal therapy for localised prostate cancer: a phase I/II trial. J Urol. 2011;185:1246–55.
Ahmed HU, Hindley RG, Dickinson L, Freeman A, Sahu M, Scott R, Allen C, Van der Meulen J, Emberton M. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. Lancet Oncol. 2012. doi:10.1016/S1470-2045(12)0121-3.
Guillaumier S, Dickinson L, Stone H, McCartan N, Thiruvel M, Hindley RG, Emberton M, Ahmed HU. High-intensity focussed ultrasound in the treatment of localised prostate cancer: focal salvage transition rates. J Urol. 2014;191(4):e714. doi: 10.1016/j.juro.2014.02.1960.
Muto S, Yoshii T, Saito K, Kamiyama Y, Ide H, Horie S. Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. Jpn J Clin Oncol. 2008;38(3):192–9. doi:10.1093/jjco/hym173. Epub 2008 Feb 15.
Uchida T, Shoji S, Nakano M, Hongo S, Nitta M, Murota A, et al. Transrectal high-intensity focused ultrasound for the treatment of localized prostate cancer: eight-year experience. Int J Urol. 2009;16:881–6.
Inoue YGK, Goto K, Hayashi T, Hayashi M. Transrectal high-intensity focused ultrasound for treatment of localized prostate cancer. Int J Urol. 2011. doi:10.1111/j.1442-2042.2011.02739.x.
Crouzet S, Rebillard X, Chevallier D, Rischmann P, Pasticier G, Garcia G, et al. Multicentric oncologic outcomes of high-intensity focused ultrasound for localized prostate cancer in 803 patients. Eur Urol. 2010;58:559–66.
Blana A, Rogenhofer S, Ganzer R, Lunz JC, Schostak M, Wieland WF, et al. Eight years’ experience with high-intensity focused ultrasonography for treatment of localized prostate cancer. Urology. 2008;72:1329–33.
Moore CM, Hoh I, Bown S, Emberton M. Does photodynamic therapy have the necessary attributes to become a future treatment for organ-confined prostate cancer? BJU Int. 2005;96:754–8.
Dougherty T, Kaufman J, Goldfarb A, Weishaupt K, Boyle D, Mittleman A. Photoradiation therapy for the treatment of malignant tumors. Cancer Res. 1978;38:2628–35.
Nathan T, Whitelaw D, Chang S, Lees W, Ripley P, Payne H, et al. Photodynamic therapy for prostate cancer recurrence after radiotherapy: a phase I study. J Urol. 2002;168:1427–32.
Trachtenburg J, Weersink R, Davidson S, Haider M, Bogaards A, Gertner M, et al. Vascular-targeted photodynamic therapy (padoporfin, WST09) for recurrent prostate cancer after failure of external beam radiotherapy: a study of escalating light doses. BJU Int. 2008;102:556–62.
Moore C, Nathan T, Lees W, Freeman A, Emberton M, Bown S. Photodynamic therapy using meso tetra hydroxyl phenyl chlorin (mTHPC) in early prostate cancer. Lasers Surg Med. 2006;385:356–63.
Leveille R, Pease K, Salas N. Emerging needle ablation technology in urology. Curr Opin Urol. 2014;24(1):98–103.
Neal R, Millar J, Kavnoudias H, Boyce P, Rosenfeldt F, Pham A, et al. In vivo characterization and numerical simulation of prostate properties for non-thermal irreversible electroporation ablation. Prostate. 2014;74(5):458–68.
Tsivian M, Polascik T. Bilateral focal ablation of prostate tissue using low-energy direct current (LEDC): a preclinical canine study. BJU Int. 2013;112(4):526–30.
Valerio M, Stricker PD, Ahmed HU, Dickinson L, Ponsky L, Shnier R, et al. Initial assessment of safety and clinical feasibility of irreversible electroporation in the focal treatment of prostate cancer. Prostate Cancer Prostatic Dis. 2014;17(4):343–7. doi: 10.1038/pcan.2014.33.
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Guillaumier, S., Emberton, M., Ahmed, H.U. (2015). Focal or Multifocal Therapy in Prostate Cancer: New Technologies and Strategies. In: Thüroff, S., Chaussy, C. (eds) Focal Therapy of Prostate Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-14160-2_7
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