How to Create Evidence for Focal PCa Therapy Research? HIFU Focal Hemiablation as Non-invasive Therapeutic Option

Abstract

The intention of focal therapy of prostate cancer is to offer the patient a partial treatment of prostate containing only the areas of significant cancer. The goal is a reduction of potential side effects of radical treatment. These side effects are typically caused by collateral damage of anatomical structures adjacent to the prostate, such as the urethral sphincter, the erectile nerves, the bladder neck and the rectum. The need to create more evidence of focal therapy strategies is illustrated against the background of the growing evidence of prostate cancer overtreatment and the related side effects. According to a recent review summarising the situation of overdiagnosis and overtreatment, Loeb et al. (Eur Urol 65(6):1046–1055, 2014) showed that overtreatment is estimated to be present in a range of 5–46.8 % in published radical prostatectomy series.

Although outcome of radical prostatectomy has improved over the last years, it may still be associated with significant morbidity even in the hands of high-volume surgeons. In a series of 380 preoperatively potent patients, Shikanov et al. showed already in 2009 that the trifecta (continence, potency and undetectable PSA) was achieved in only 44 % of patients 24 months following nerve-sparing robotic-assisted radical prostatectomy (RALP).