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Focal Therapy and Active Surveillance in Europe

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Imaging and Focal Therapy of Early Prostate Cancer

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

Prostate cancer (PCa) is one of the most commonly diagnosed cancers in European men, and its management is highly complex. This is especially true for localized and low-risk disease owing to the many factors that influence decision-making, including the wide range of available interventions, each of which is associated with different treatment characteristics and adverse effects. Furthermore, there are still many uncertainties regarding the most accurate ways of determining the grade and stage of disease and evaluating the prognosis. Approximately 20–50 % of men diagnosed with low-risk disease harbor high-grade PCa that is misclassified in biopsy. In addition, a small number of low-grade PCa have molecular alterations resulting in progression to unfavorable disease. Low-risk PCa may be managed by controlled and regular follow-up (active surveillance).

In turn, more and more interest is rising around the possibility of treating the part of the prostate containing the obvious cancer (focal therapy). The concept of treating an index lesion in the prostate to control PCa is of increasing interest to European urologists and oncologists. The goals of focal therapy itself are commendable, namely, reducing the morbidity of treatment while ensuring at least equivalent oncological outcomes compared with established interventions for localized PCa such as radical prostatectomy (RP) and external beam radiation therapy. However, concerns exist about the validity of the index lesion theory, the ablative technologies being used to deliver FT, and the design of recent and current studies evaluating FT for localized PCa. Focal therapy aims to preserve tissue and function in men who have been diagnosed with localized PCa, as an alternative to whole-gland radiation or RP. Furthermore, there is growing interest in the use of FT to reduce treatment-related toxicity, minimizing damage to the adjacent structures. Currently, any approach able to preserve part of the prostatic tissue (hockey-stick ablation, hemi-ablation, and focal ablation) is considered focal therapy.

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Authors and Affiliations

  1. Department of Urology, Universitätsklinikum Heidelberg, Heidelberg, Baden-Württemberg, Germany

    Jan Philipp Radtke & Markus Hohenfellner

  2. Department of Radiology, German Cancer Research Center, Heidelberg, Germany

    Jan Philipp Radtke

  3. Department of Urology, University Autonoma of Barcelona, Fundaciò Puigvert, Barcelona, Spain

    Angelo Territo & Alberto Breda

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  1. Jan Philipp Radtke
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  2. Angelo Territo
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  3. Markus Hohenfellner
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  4. Alberto Breda
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Correspondence to Jan Philipp Radtke .

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  1. Department of Surgery, Duke Cancer Institute, Durham, North Carolina, USA

    Thomas J. Polascik

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Radtke, J.P., Territo, A., Hohenfellner, M., Breda, A. (2017). Focal Therapy and Active Surveillance in Europe. In: Polascik, T. (eds) Imaging and Focal Therapy of Early Prostate Cancer. Current Clinical Urology. Springer, Cham. https://doi.org/10.1007/978-3-319-49911-6_5

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