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Focal Therapies for Localized Prostate Cancer

  • Louise Dickinson
  • Hashim U. Ahmed
  • Mark Emberton
Chapter

Abstract

Men diagnosed with low-risk localized prostate cancer face a difficult decision between two extremes of care: active surveillance and radical therapies. The former entails living with the diagnosis of untreated cancer and the risk of progression; the latter provides a greater certainty of cancer control but with a significant side effect risk. Focal therapy potentially offers cancer control, without the side effect profile of radical therapies. Ablation is targeted at the cancer itself with preservation of surrounding normal tissue.

Evaluation of suitable candidates for focal therapy involves accurate disease detection, characterization, and localization. The current use of transrectal biopsies within the prostate cancer diagnostic pathway is likely to be insufficient for this purpose. Different imaging modalities and alternative biopsy techniques have demonstrated promise in the ability to accurately detect, localize, and characterize disease and are likely to take on an important role within focal therapy planning and follow-up.

There are a number of energy sources currently undergoing evaluation as focal therapies within phase I/II trials including cryotherapy, high intensity focused ultrasound and photodynamic therapy. Other new techniques have the potential to be applied in this manner.

This chapter explores the concepts behind focal therapy as an alternative to current “standard” care and the strategies that may be employed to select candidates for this form of treatment. The clinical data is reviewed for current tissue-preserving techniques and potential future therapies.

Keywords

Prostate Cancer Radical Prostatectomy Active Surveillance Prostate Biopsy Localize Prostate Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Suggested Additional Reading

  1. Ahmed HU, Freeman A, Kirkham A, Sahu M, Scott R, Allen C, Van der Meulen J, Emberton M. Focal therapy for localized prostate cancer: a phase I/II trial. J Urol. 2011;185(4):1246–54.PubMedCrossRefGoogle Scholar
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Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Louise Dickinson
    • 1
  • Hashim U. Ahmed
    • 2
  • Mark Emberton
    • 3
  1. 1.Clinical Research Fellow and NIHR Academic Specialist Registrar in Urology, Department of UrologyUniversity College London Hospitals NHS Foundation Trust and Division of Surgery and Interventional Science, University CollegeLondonUK
  2. 2.Medical Research Council (MRC) Clinician Scientist and Clinical Lecturer in Urology, Department of UrologyUniversity College London Hospitals NHS Foundation Trust and Division of Surgery and Interventional Science, University CollegeLondonUK
  3. 3.Surgery and Honorary Consultant Urological Surgeon, Department of UrologyUniversity College London Hospitals NHS Foundation Trust and Division of Surgery and Interventional Science, University CollegeLondonUK

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