Using Focal Therapy for Targeted Prostate Cancer Treatment

Using Focal Therapy for Targeted Prostate Cancer Treatment

(By Jeni Crockett-Holme)

Keywords: Prostate cancer, Focal therapy, Outcomes, Prostatectomy, MRI

Radical prostatectomy (removal of the whole prostate) has long been the standard treatment for prostate cancer [1,2]. This approach removes the cancer but often results in subsequent incontinence and erectile dysfunction as well as other complications.

New research shows that focal therapy may be a promising alternative [2,3]. This minimally invasive technique is able to target tumors and limit damage to surrounding tissue [4]. The majority of patients who have had focal treatment for prostate cancer were cancer free with few side effects following the procedure [2]. Until long-term outcomes can be determined, this approach should be considered investigational [3].

The study
A study of treatment outcomes with focal therapy for prostate cancer showed encouraging results in a group of 25 men [3]. The men had cancer that was limited to the prostate (clinically localized, T1c and T2a), a PSA level lower than 10 ng/ml, a Gleason score less than 8, and one or two areas of cancer that could be seen with an MRI scan. Most were not eligible for active surveillance.

These patients received “focal laser ablation,” in which a laser probe was inserted into the prostate while the patient lay in an MRI scanner. The MRI scan showed the area of cancer, and then the laser probe was moved there and heated to destroy the tumor tissue. This process was repeated as needed depending on the size of each patient’s area of cancer.

Results
Patients recovered quickly with virtually no effect on their quality of life. None experienced incontinence. Seven men (28%) required a urinary catheter to assist with urination following the procedure but were able to urinate independently within 3 days.

On average, the men were able to return to work within 1 day, resume normal physical activities within 3.5 days, and resume sexual activity within 7.5 days. After 3 months, PSA levels for all patients had decreased by at least 40%, of the biopsies taken – 96% were cancer free, and MRI showed no characteristics of prostate cancer in this group.

Practical implications
This small study showed that focal laser ablation is feasible and safe for treatment of localized prostate cancer. These results are considered preliminary, and follow-up was short term. It is possible to use this technique to treat localized prostate cancer that has been proven by biopsy and identified by MRI. Focal laser ablation of prostate cancer is currently investigational because long-term outcomes are as yet unknown.

[1] EAU patient information: localized prostate cancer. http://patients.uroweb.org/fileadmin/files/english/PCa/03_Localized_prostate_cancer.pdf. Accessed November 6, 2015.

[2] Ahmed HU, Dickinson L, Charman S, et al. Focal ablation targeted to the index lesion in multifocal localised prostate cancer: a prospective development study. Eur Urol 2015;68:927–36.

[3] Lepor H, Llukani E, Sperling D, Fütterer JJ. Complications, recovery, and early functional outcomes and oncologic control following in-bore focal laser ablation of prostate cancer. Eur Urol 2015;68:924–6.

[4] EAU patient information: glossary of terms prostate cancer. http://patients.uroweb.org/fileadmin/files/english/PCa/Glossary_of_terms_prostate_cancer.pdf. Accessed November 6, 2015.
Link to patient information: http://patients.uroweb.org/fileadmin/files/english/PCa/03_Localized_prostate_cancer.pdf
Link to prostate cancer glossary: http://patients.uroweb.org/fileadmin/files/english/PCa/Glossary_of_terms_prostate_cancer.pdf
Link to prostate cancer glossary: http://patients.uroweb.org/fileadmin/files/english/PCa/Glossary_of_terms_prostate_cancer.pdf
Link to patient information: http://patients.uroweb.org/fileadmin/files/english/PCa/03_Localized_prostate_cancer.pdf
Link to prostate cancer glossary: http://patients.uroweb.org/fileadmin/files/english/PCa/Glossary_of_terms_prostate_cancer.pdf
Link to prostate cancer glossary: http://patients.uroweb.org/fileadmin/files/english/PCa/Glossary_of_terms_prostate_cancer.pdf
Link to prostate cancer glossary: http://patients.uroweb.org/fileadmin/files/english/PCa/Glossary_of_terms_prostate_cancer.pdf
Link to prostate cancer glossary: http://patients.uroweb.org/fileadmin/files/english/PCa/Glossary_of_terms_prostate_cancer.pdf
Link to prostate cancer glossary: http://patients.uroweb.org/fileadmin/files/english/PCa/Glossary_of_terms_prostate_cancer.pdf

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