Roadmap for Focal Therapy

Abstract

The future success of focal therapy for early stage prostate cancer will depend upon a multidisciplinary effort to find and implement solutions to several existing clinical problems that provide the historical dogma for whole gland treatment. For focal therapy to succeed as an accepted treatment option, preservation of genitourinary function is vital without compromising cancer efficacy. The first challenge is to identify appropriate candidates who can benefit from focal therapy based upon that patient’s specific tumor characteristics. We need to be able to better determine the biological potential of each cancer within the prostate by developing novel markers of aggression. Imaging needs to become reliable at defining the precise three-dimensional structure and location of each tumor, and perhaps provide functional information about the tumor in terms of its ability to invade or metastasize. Robotics and automation need to be developed and incorporated into guidance systems to allow for accurate primary targeting and secondary reproducibility if the lesion needs to be targeted again, either for post-treatment biopsy or additional therapy. Since some of the prostate will not be deliberately treated, active surveillance of these non-malignant areas with chemoprevention strategies become paramount in an effort to prevent subsequent cancers from developing in untreated sectors of the prostate. Finally, strict outcome criteria and surveillance strategies need to be established that allow for meaningful comparisons among centers and their techniques.