Skip to main content

Advertisement

Log in

Current state of image-guided focal therapy for prostate cancer

World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To review the current evidence regarding protocols and outcomes of image-guided focal therapy (FT) for prostate cancer (PCa).

Methods

A literature search of the latest published studies assessing primary FT for PCa was carried out in Medline and Cochrane library databases followed by a critical review. FT modalities, follow-up strategies, and oncological and toxicity outcomes were summarized and discussed in this review.

Results

Twenty-four studies with six different sources of energy met the inclusion criteria. A heterogeneity of patient selection, energy sources, treatment templates, and definitions of failure was found among the studies. While a third of patients may be found to have additional cancer burden over 3–5 years following FT, most patients will remain free of a radical procedure. The vast majority of patients maintain urinary continence and good erectile function after FT. Acute urinary retention is the most common complication, whilst severe complications remain rare.

Conclusion

An increasing number of prospective studies with longer follow-up have been recently published. Acceptable cancer control and low treatment toxicity after FT have been consistently reported. Follow-up imaging and routine biopsy must be encouraged post-FT. While there is no reliable PSA threshold to predict failure after FT, reporting post-FT positive biopsies and retreatment rates appear to be standard when assessing treatment efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Tyson MD, Koyama T, Lee D et al (2018) Effect of prostate cancer severity on functional outcomes after localized treatment: comparative effectiveness analysis of surgery and radiation study results. Eur Urol 74(1):26–33

    PubMed  PubMed Central  Google Scholar 

  2. Polascik TJ, Mouraviev V (2009) Focal therapy for prostate cancer is a reasonable treatment option in properly selected patients. Urology 74:726–730

    PubMed  Google Scholar 

  3. Baco E, Ukimura O, Rud E et al (2015) Magnetic resonance imaging—transectal ultrasound image-fusion biopsies accurately characterize the index tumor: correlation with step-sectioned radical prostatectomy specimens in 135 patients. Eur Urol 67(4):787–794

    PubMed  Google Scholar 

  4. Tay KJ, Amin MB, Ghai S et al (2018) Surveillance after prostate focal therapy. World J Urol 37(3):397–407

    PubMed  Google Scholar 

  5. Valerio M, Cerantola Y, Eggener SE et al (2017) New and established technology in focal ablation of the prostate: a systematic review. Eur Urol 71(1):17–34

    PubMed  Google Scholar 

  6. Lodeizen O, de Bruin M, Eggener S et al (2019) Ablation energies for focal treatment of prostate cancer. World J Urol 37(3):409–418

    PubMed  Google Scholar 

  7. Ward JF, Nakanishi H, Pisters L et al (2009) Cancer ablation with regional templates applied to prostatectomy specimens from men who were eligible for focal therapy. BJU Int 104(4):490–497

    PubMed  Google Scholar 

  8. Jones JS (2007) Focal or subtotal therapy for early stage prostate cancer. Curr Treat Options Oncol 8(3):165–172

    PubMed  Google Scholar 

  9. Guillaumier S, Peters M, Arya M et al (2018) A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer. Eur Urol 74(4):422–429

    PubMed  PubMed Central  Google Scholar 

  10. Rischmann P, Gelet A, Riche B et al (2017) Focal high intensity focused ultrasound of unilateral localized prostate cancer: a prospective multicentric hemiablation study of 111 patients. Eur Urol 71(2):267–273

    PubMed  Google Scholar 

  11. Albisinni S, Aoun F, Belluccci S et al (2017) Comparing high-intensity focal ultrasound hemiablation to robotic radical prostatectomy in the management of unilateral prostate cancer: a matched-pair analysis. J Endourol 31(1):14–19

    PubMed  Google Scholar 

  12. Ganzer R, Hadaschik B, Pahernik S et al (2018) Prospective multicenter phase II study on focal therapy(hemiablation) of the prostate with high intensity focused ultrasound. J Urol 199(4):983–989

    PubMed  Google Scholar 

  13. Johnston MJ, Emara A, Noureldin M et al (2019) Focal high-intensity focussed ultrasound partial gland ablation for the treatment of localised prostate cancer: a report of medium-term outcomes from a single-center in the United Kingdom. Urology 133:175–181

    PubMed  Google Scholar 

  14. Tourinho-Barbosa RR, Sanchez-Salas R, Claros OR et al (2019) Focal therapy for localized prostate cancer with either HIFU or cryoablation: a single institution experience. J Urol. https://doi.org/10.1097/JU.0000000000000506

    Article  PubMed  Google Scholar 

  15. Mortezavi A, Krauter J, Gu A et al (2019) Extensive histological sampling following focal therapy of clinically significant prostate cancer with high intensity focused ultrasound. J Urol 202(4):717–724

    PubMed  Google Scholar 

  16. Stabile A, Orczyk C, Hosking-Jervis F et al (2019) Medium-term oncological outcomes in a large cohort of men treated with either focal or hemi-ablation using high-intensity focused ultrasonography for primary localized prostate cancer. BJU Int 124(3):431–440

    PubMed  Google Scholar 

  17. von Hardenberg J, Westhoff N, Baumunk D et al (2018) Prostate cancer treatment by the latest focal HIFU device with MRI/TRUS-fusion control biopsies: a prospective evaluation. Urol Oncol 36(9):401.e1–401.e9

    Google Scholar 

  18. Schmid FA, Schindele D, Mortezavi A et al (2019) Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer. Urol Oncol. https://doi.org/10.1016/j.urolonc.2019.09.001

    Article  PubMed  Google Scholar 

  19. Tay KJ, Polascik TJ, Elshafei A et al (2017) Propensity score-matched comparison of partial to whole-gland cryotherapy for intermediate-risk prostate cancer: an analysis of the cryo on-line data registry data. J Endourol 31(6):564–571

    PubMed  Google Scholar 

  20. Shah TT, Peters M, Eldred-Evans D et al (2019) Early-medium-term outcomes of primary focal cryotherapy to treat nonmetastatic clinically significant prostate cancer from a prospective multicentre registry. Eur Urol 76(1):98–105

    PubMed  Google Scholar 

  21. Kongnyuy M, Lipsky MJ, Islam S et al (2017) Predictors of biochemical recurrence after primary focal cryosurgery (hemiablation) for localized prostate cancer: a multi-institutional analytic comparison of Phoenix and Stuttgart criteria. Urol Oncol 35(8):530.e15–530.e19

    Google Scholar 

  22. Oishi M, Gill IS, Tafuri A et al (2019) Hemigland cryoablation of localized low, intermediate and high risk prostate cancer: oncologic and functional outcomes at 5 years. J Urol 202(6):1188–1198

    PubMed  Google Scholar 

  23. Azzouzi A, Vincendeau S, Barret E et al (2017) Padeliporfin vascular-targeted photodynamic therapy versus active surveillance in men with low-risk prostate cancer (CLIN1001 PCM301): an open-label, phase 3, randomised controlled trial. Lancet Oncol 18(2):181–191

    CAS  PubMed  Google Scholar 

  24. Noweski A, Roosen A, Lebdai S et al (2019) Medium-term follow-up of vascular-targeted photodynamic therapy of localized prostate cancer using TOOKAD soluble WST-11 (Phase II trials). Eur Urol Focus 5(6):1022–1028

    CAS  PubMed  Google Scholar 

  25. Rodriguez-Rivera JA, Rodriguez-Lay R, Zegarra-Montes L et al (2018) Expanding indication of padeliporfin (WST11) vascular-targeted photodynamic therapy: results of prostate cancer Latin-American multicenter study. Actas Urol Esp 42(10):632–638

    CAS  PubMed  Google Scholar 

  26. Blazevski A, Scheltema MJ, Yuen B et al (2019) Oncological and quality-of-life outcomes following focal irreversible electroporation as primary treatment for localised prostate cancer: a biopsy-monitored prospective cohort. Eur Urol Oncol. https://doi.org/10.1016/j.euo.2019.04.008

    Article  PubMed  Google Scholar 

  27. Valerio M, Dickinson L, Ali A et al (2017) Nanoknife electroporation ablation trial: a prospective development study investigating focal irreversible electroporation for localized prostate cancer. J Urol 197(3):647–654

    PubMed  Google Scholar 

  28. Collettini F, Enders J, Stephan C et al (2019) Image-guided irreversible electroporation of localized prostate cancer: functional and oncologic outcomes. Radiology 292(1):250–257

    PubMed  Google Scholar 

  29. Chao B, Llukani E, Lepor H (2018) Two-year outcomes following focal laser ablation of localized prostate cancer. Eur Urol Oncol 1(2):129–133

    PubMed  Google Scholar 

  30. Walser E, Nance A, Ynalvez L et al (2019) Focal laser ablation of prostate cancer: results in 120 patients with low- to intermediate-risk disease. J Vasc Interv Radiol 30(3):401–409

    PubMed  Google Scholar 

  31. Peters M, van Son MJ, Moerland MA et al (2019) MRI-guided ultrafocal HDR brachytherapy for localized prostate cancer: median 4-year results of a feasibility study. Int J Radiat Oncol Biol Phys 104(5):1045–1053

    PubMed  Google Scholar 

  32. Graff P, Portalez D, Lusque A et al (2018) IDEAL 2a phase II study of ultrafocal brachytherapy for low- and intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys 102(4):903–911

    PubMed  Google Scholar 

  33. Tay KJ, Scheltema MJ, Ahmed HU (2017) Patient selection for prostate focal therapy in the era of active surveillance: an International Delphi Consensus Project. Prostate Cancer Prostatic Dis 20(3):294–299

    CAS  PubMed  Google Scholar 

  34. Scheltema MJ, Tay KJ, Postema AW et al (2017) Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project. World J Urol 35(5):695–701

    CAS  PubMed  Google Scholar 

  35. Ahdoot M, Wilbur AR, Reese SE et al (2020) MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N Engl J Med 382(10):917–928

    PubMed  PubMed Central  Google Scholar 

  36. Kennedy JE, Ter Haar GR, Cranston D (2003) High intensity focused ultrasound: surgery of the future? Br J Radiol 76(909):590–599

    CAS  PubMed  Google Scholar 

  37. Nguyen HD, Allen BJ, Pow-Sang JM (2013) Focal cryotherapy in the treatment of localized prostate cancer. Cancer Control 20(3):177–180

    PubMed  Google Scholar 

  38. Azzouzi A, Barret E, Moore CM et al (2013) TOOKAD((R)) Soluble vascular-targeted photodynamic (VTP) therapy: determination of optimal treatment conditions and assessment of effects in patients with localised prostate cancer. BJU Int 112(6):766–774

    CAS  PubMed  Google Scholar 

  39. Al-Sakere B, André F, Bernat C et al (2007) Tumor ablation with irreversible electroporation. PLoS ONE 2(11):e1135

    PubMed  PubMed Central  Google Scholar 

  40. Lepor H, Llukani E, Sperling D et al (2015) Complications, recovery, and early functional outcomes and oncologic control following in-bore focal laser ablation of prostate cancer. Eur Urol 68(6):924–926

    PubMed  Google Scholar 

  41. Cosset JM, Cathelineau X, Wakil G et al (2013) Focal brachytherapy for selected low-risk prostate cancers: a pilot study. Brachytherapy 12(4):331–337

    PubMed  Google Scholar 

  42. Sivaraman A, Barret E (2016) Focal therapy for prostate cancer: an “À la Carte” approach. Eur Urol 69(6):973–975

    PubMed  Google Scholar 

  43. Ashrafi AN, Nassiri N, Gill IS et al (2018) Contrast-enhanced transrectal ultrasound in focal therapy for prostate cancer. Curr Urol Rep 19(10):87

    PubMed  Google Scholar 

  44. Claros OR, Tourinho-Barbosa RR, Carneiro A (2019) HIFU focal therapy for prostate cancer using intraoperatory contrast enhanced ultrasound. Arch Esp Urol 78(8):825–830

    Google Scholar 

  45. Kongnyuy M, Islam S, Mbah AK et al (2018) PSA kinetics following primary focal cryotherapy (hemiablation) in organ-confined prostate cancer patients. World J Urol 36(2):209–213

    CAS  PubMed  Google Scholar 

  46. Tourinho-Barbosa RR, de la Rosette J, Sanchez-Salas R (2018) Prostate cancer multifocality, the index lesion, and the microenvironment. Curr Opin Urol 28(6):499–505

    PubMed  Google Scholar 

  47. Kadono Y, Machioka K, Nakashima K et al (2017) Changes in penile length after radical prostatectomy: investigation of the underlying anatomical mechanism. BJU Int 120(2):293–299

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

RRT-B: literature search/data analysis/manuscript writing. BJW: critical revision. ALA: literature search/data analysis/critical revision. BN: critical revision/manuscript writing. TS: literature search/critical revision. SG: critical revision. TJP: data analysis/manuscript writing/critical revision

Corresponding author

Correspondence to Rafael R. Tourinho-Barbosa.

Ethics declarations

Conflict of interest

The authors declared no conflicts of interest.

Research involving human participants and/or animals

No human subjects or animals were involved in this study.

Informed consent

Due to the nature of this article, acquisition of informed consent is not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tourinho-Barbosa, R.R., Wood, B.J., Abreu, A.L. et al. Current state of image-guided focal therapy for prostate cancer. World J Urol 39, 701–717 (2021). https://doi.org/10.1007/s00345-020-03254-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-020-03254-4

Keywords

Navigation