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Active surveillance and radical therapy in prostate cancer: can focal therapy offer the middle way?

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Abstract

Introduction

Focal therapy for prostate cancer is a radical paradigm shift in the management of men with localised prostate cancer. It involves locating and destroying only the areas of prostate cancer whilst leaving the majority of the prostate untreated. By doing so, it is proposed that side-effects of traditional whole-gland therapies such as impotence, incontinence and rectal toxicity will be significantly reduced and cancer control will be at similar levels.

Methods and materials

A Medline/Pubmed search was conducted between 1 May 1998 and 1 May 2008 using the following terms: 'focal therapy', 'lumpectomy', 'hemiablation', 'laterality', 'multifocal', 'unifocal' and 'index lesion' alongside 'prostate cancer'. Articles were selected for their relevance to this review. Abstracts from international conferences over the last 5 years were also used where appropriate. Authors' personal bibliography was used to supplement the review.

Conclusions

A number of case series have reported significantly lower incontinence and impotence rates using focal cryoablation and one series on focal HIFU. The reporting quality has been variable and there are currently ongoing clinical trials with IRB approval in the USA and UK. Long term follow-up is required. Focal therapy is an exciting new area of research that could hold great promise for men with localised low to intermediate risk prostate cancer.

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Conflicts of interest statement

Hashim Uddin Ahmed and Mark Emberton receive funding from Cancer Research UK, Pelican Cancer Foundation, Basingstoke, UK, The Prostate Research Campaign UK, St Peter's Trust UK, and the Prostate Cancer Research Centre for work in focal therapy. Hashim Ahmed will receive funding from the Medical Research Council from October 2008. In addition, Mark Emberton receives funding from Steba Biotech/Negma Lerads, France (manufacturers of TOOKAD, a photodynamic agent used in prostate cancer therapy). Both receive funding from UKHIFU Ltd, USHIFU, Misonix and Focused Surgery (Manufacturers and distributors of the Sonablate® 500 HIFU device) and Misonix Inc (distributors of the Sonablate® 500 HIFU device) for attendance at meetings and as Medical Consultant. Both are Company Directors of Prostate Mapping Ltd. None of the funding sources had any role in the writing of this article.

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    Hashim Uddin Ahmed & Mark Emberton

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Correspondence to Hashim Uddin Ahmed.

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Ahmed, H.U., Emberton, M. Active surveillance and radical therapy in prostate cancer: can focal therapy offer the middle way?. World J Urol 26, 457–467 (2008). https://doi.org/10.1007/s00345-008-0317-5

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