Targeting the cancer lesion, not the whole prostate

Abstract

Modern cancer treatment aims to conserve as much healthy tissue as possible. This has been challenging in the treatment of prostate cancer due to the difficulty in imaging the gland and concerns over leaving multifocal cancer untreated. With improvements in imaging and understanding of multifocal prostate cancer evidence now shows accurate treatment of just the primary focus of cancer or the index lesion can control progression or recurrence of the disease. Many different energy sources are now available to target the cancer lesion within the prostate with less significant side-effects on urinary and sexual function compared to radical treatment. Evidence shows that men value these functions highly and would even trade years of life in exchange for preserved retention of continence or erectile function. Focal treatment of prostate cancer aims to provide both cancer control and preservation of sexual and urinary functions so that men do not have to make a choice between the two. This is a treatment option that men clearly want and deserve.

One-year Follow-up Results of Transperineal Biopsy For Patients Undergoing Irreversible Electroporation Treatment in Localized Prostate Cancer

“…Recent studies conducted with this principle have demonstrated that treating index lesions prevents recurrence or the development of new lesions. 7 - 9 , 13 - 15 , 18 …”

Machine learning prediction of Gleason grade group upgrade between in-bore biopsy and radical prostatectomy pathology

“…All index lesions detected on mp-MRI and sampled by in-bore biopsy were confirmed at whole-mount step-section specimens after RP. Since non-index lesions were not clinically related to patient outcomes, they were not analyzed 10 – 13 .…”

Developments in Vascular-Targeted Photodynamic Therapy for Urologic Malignancies

“…The development and wider use of other types of focal therapy as high-intensity focused ultrasound (HIFU) and electroporation contributed to improve PDT techniques. Moreover, the advances in imaging methods including multiparametric magnetic resonance imaging have improved the accuracy of prostatic lesion localization, particularly clinically significant disease [ 17 ]. These advances made greater accuracy in the insertion of lighting fibers possible, increasing the effectiveness of PDT-based therapies.…”

“…The natural access throughout the urethra and the well-developed ureteroscopy technics provide the possibility of accessing the tumors without needing insertion with minor aggressiveness. The use of the photosensitizer has helped to improve tumor detection in this setting [ 17 , 18 , 19 , 20 ].…”