What is the role of focal therapy in low-risk prostate cancer?

In the July issue of European Urology, the scientific journal of the European Association of Urology (EAU), S. Eggener et al. discussed in a recent study the significance and impact of focal therapy for low-risk cancer patients.

Since the introduction of prostate cancer screening based on prostate-specific antigen (PSA), over-treatment has increased. A significant proportion of patients diagnosed with prostate cancer have well differentiated, low-volume tumours at minimal risk of impacting their quality of life or longevity. The selection of a treatment strategy, among the multitude of options, has enormous implications for individuals and health care systems.

A conceptually appealing option to patients uncomfortable with observational strategies yet highly concerned about the risks of whole-gland treatment is to bridge elements of active surveillance with whole-gland therapy. This hybrid approach, termed focal therapy, aims to eradicate known cancer foci with the highest likelihood of progressing or metastasizing while attempting to diminish collateral damage to the vital structures essential for maintaining normal urinary and sexual function.

Limitations of focal therapy include the inability to stage or grade the cancer(s) accurately, suboptimal imaging capabilities, uncertainty regarding the natural history of untreated cancer foci, challenges with post-treatment monitoring, and the lack of quality-of-life data compared with alternative treatment strategies.

The aim of the present study was to review the rationale, patient selection criteria, diagnostic imaging, biopsy schemes, and treatment modalities available for the focal therapy of localized prostate cancer.

A National Center for Biotechnology Information PubMed search (www.pubmed.gov) was performed from 1995 to 2009 using medical subject headings ''focal therapy'' or ''ablative'' and ''prostate cancer'.' Additional articles were extracted based on recommendations from an expert panel of authors.

One of the conclusions of the study is that focal therapy for prostate cancer is a promising and emerging treatment strategy for men with a low risk of cancer progression or metastasis. Evaluation in formal prospective clinical trials is essential before this new strategy is accepted in clinical practice.

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Focal Therapy for Prostate Cancer: Possibilities and Limitations
Scott Eggener, Georg Salomon, Peter T. Scardino, Jean De la Rosette, Thomas J. Polascik, Simon Brewster

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Contact: Lindy Brouwer
l.brouwer@uroweb.org
European Association of Urology