Focal Therapy in Primary Localised Prostate Cancer : The European Association of Urology Position in 2018

Abstract

Focal therapy of prostate cancer is the targeted destruction of cancer within a specific part of the prostate gland, sparing the rest of the prostate and nearby tissue. This procedure could potentially reduce side effects when compared with established standard treatments, such as surgery or radiotherapy, which treat the entire prostate. Studies show that for most men with low-risk cancer, active surveillance is the preferred treatment option. However, the available data regarding all forms of focal therapy are still poor and inconclusive. Consequently, due to both the lack of clear results associated with focal therapy and the difficulties in detecting all cancerous areas of the prostate, focal therapy should be considered an investigational modality only.

IMPROD biparametric MRI in men with a clinical suspicion of prostate cancer (IMPROD Trial): Sensitivity for prostate cancer detection in correlation with whole‐mount prostatectomy sections and implications for focal therapy

“…High sensitivity at the voxel level is important for focal therapy planning. 29 We have shown that 10-12 mm distance (corresponding to the Hausdorff distance) of prospectively delineated lesions led to sensitivity approaching 95% in the majority of IMPROD bpMRI-detected lesions. In order to achieve close to 100% sensitivity, increasing IMPROD bpMRI manual declinations by~10-12 mm in all directions was necessary ( Table 3).…”

“…In the current study, high sensitivity at the ROI level (within the whole prostate) was achieved, in contrast to the sensitivity at the voxel level, which was limited. High sensitivity at the voxel level is important for focal therapy planning . We have shown that ~10–12 mm distance (corresponding to the Hausdorff distance) of prospectively delineated lesions led to sensitivity approaching 95% in the majority of IMPROD bpMRI‐detected lesions.…”

Irreversible electroporation (IRE): a narrative review of the development of IRE from the laboratory to a prostate cancer treatment

“…While IRE is a promising focal ablative technique with good short-term oncological results and minimal morbidity, it should still be considered an investigational treatment performed only as part of prospective clinical registry studies or randomised trials until more long-term data are available [43,44].…”

Salvage high‐intensity focused ultrasound for locally recurrent prostate cancer after low‐dose‐rate brachytherapy: oncological and functional outcomes

“…Most mpMRIs were performed with a pelvic phased-array coil without an endorectal coil. Systematic TRUS biopsies of the prostate (12 cores according to a standard scheme: two per sextant), one biopsy of the proximal part of each seminal vesicle, and at least two biopsies in each mpMRI target, were taken [17]. Initial metastatic evaluations included bone scan and thoracoabdomino-pelvic CT.…”