The Role of Focal Therapy in the Management of Localised Prostate Cancer: A Systematic Review

Abstract

ContextThe incidence of localised prostate cancer is increasing worldwide. In light of recent evidence, current, radical, whole-gland treatments for organ-confined disease have being questioned with respect to their side effects, cancer control, and cost. Focal therapy may be an effective alternative strategy.ObjectiveTo systematically review the existing literature on baseline characteristics of the target population; preoperative evaluation to localise disease; and perioperative, functional, and disease control outcomes following focal therapy.Evidence acquisitionMedline (through PubMed), Embase, Web of Science, and Cochrane Review databases were searched from inception to 31 October 2012. In addition, registered but not yet published trials were retrieved. Studies evaluating tissue-preserving therapies in men with biopsy-proven prostate cancer in the primary or salvage setting were included.Evidence synthesisA total of 2350 cases were treated to date across 30 studies. Most studies were retrospective with variable standards of reporting, although there was an increasing number of prospective registered trials. Focal therapy was mainly delivered to men with low and intermediate disease, although some high-risk cases were treated that had known, unilateral, significant cancer. In most of the cases, biopsy findings were correlated to specific preoperative imaging, such as multiparametric magnetic resonance imaging or Doppler ultrasound to determine eligibility. Follow-up varied between 0 and 11.1 yr. In treatment-naïve prostates, pad-free continence ranged from 95% to 100%, erectile function ranged from 54% to 100%, and absence of clinically significant cancer ranged from 83% to 100%. In focal salvage cases for radiotherapy failure, the same outcomes were achieved in 87.2–100%, 29–40%, and 92% of cases, respectively. Biochemical disease-free survival was reported using a number of definitions that were not validated in the focal-therapy setting.ConclusionsOur systematic review highlights that, when focal therapy is delivered with intention to treat, the perioperative, functional, and disease control outcomes are encouraging within a short- to medium-term follow-up. Focal therapy is a strategy by which the overtreatment burden of the current prostate cancer pathway could be reduced, but robust comparative effectiveness studies are now required.

Follow-up modalities in focal therapy for prostate cancer: results from a Delphi consensus project

“…In this final meeting, the results of the questionnaires were presented to the panelists, and conclusions were formulated. 1 The meeting was recorded for documentation purposes.…”

“…Focal therapy offers a middle ground approach as a disease management strategy in a select group of men with low-and intermediate-risk prostate cancer (PCa), positioned between active surveillance on one side and radical treatment on the other side [1]. The factors that prohibit focal therapy from becoming standard of care are multiple: a lack of clear definitions of what constitutes focal therapy [2], a wide variety of ablative technologies available and lack of substantial standardized studies, and consequently reliable outcome data.…”

New and Established Technology in Focal Ablation of the Prostate: A Systematic Review

“…This process aims to preserve as much tissue as is compatible with treating the target volume plus a margin. This approach seeks to protect from injury key structures whose integrity is essential for stable genito-urinary function (neurovascular bundles, urethral sphincter and bladder neck) (1). Further, the bladder and the rectum, two structures that can be impaired by radiation therapy, are fully preserved.…”

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 2: Liver and Other Applications in Oncology

“…Targeted treatment of the index tumor while protecting sensitive neighboring structures makes it possible to reduce treatmentassociated side effects such as erectile dysfunction and incontinence [39].…”