TY - JOUR
T1 - Focal Therapy in Primary Localised Prostate Cancer
T2 - The European Association of Urology Position in 2018
AU - van der Poel, Henk G
AU - van den Bergh, Roderick C N
AU - Briers, Erik
AU - Cornford, Philip
AU - Govorov, Alex
AU - Henry, Ann M
AU - Lam, Thomas B
AU - Mason, Malcolm D
AU - Rouvière, Olivier
AU - De Santis, Maria
AU - Willemse, Peter-Paul M
AU - van Poppel, Hendrik
AU - Mottet, Nicolas
N1 - Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.
PY - 2018/7
Y1 - 2018/7
N2 - Radical treatment of localised prostate cancer is recognised to be an unnecessary intervention or overtreatment in many men. Consequently, there has been a rapid uptake in the use of focal ablative therapies. However, there are several biological and practical concerns about such approaches as they have yet to be proved as robust treatment options. In particular, the multifocal nature of prostate cancer argues against unifocal treatment, while limitations in imaging can preclude the accurate identification of the number, location, and extent of prostate cancer foci. To date, a number of ablative options have reported results on mainly low-risk disease. Most series are relatively immature, with a lack of consistent follow-up, and the morbidity of retreatment is often not considered. The authors consider focal therapy to be an investigational modality, and encourage prospective recording of outcomes and recruitment of suitable patients. Patient summary: Focal therapy of prostate cancer is the targeted destruction of cancer within a specific part of the prostate gland, sparing the rest of the prostate and nearby tissue. This procedure could potentially reduce side effects when compared with established standard treatments, such as surgery or radiotherapy, which treat the entire prostate. Studies show that for most men with low-risk cancer, active surveillance is the preferred treatment option. However, the available data regarding all forms of focal therapy are still poor and inconclusive. Consequently, due to both the lack of clear results associated with focal therapy and the difficulties in detecting all cancerous areas of the prostate, focal therapy should be considered an investigational modality only. Focal therapy for localised prostate cancer may reduce morbidity of local therapy as well as be an alternative to active surveillance, provided that long-term data will show comparative oncological outcome.
AB - Radical treatment of localised prostate cancer is recognised to be an unnecessary intervention or overtreatment in many men. Consequently, there has been a rapid uptake in the use of focal ablative therapies. However, there are several biological and practical concerns about such approaches as they have yet to be proved as robust treatment options. In particular, the multifocal nature of prostate cancer argues against unifocal treatment, while limitations in imaging can preclude the accurate identification of the number, location, and extent of prostate cancer foci. To date, a number of ablative options have reported results on mainly low-risk disease. Most series are relatively immature, with a lack of consistent follow-up, and the morbidity of retreatment is often not considered. The authors consider focal therapy to be an investigational modality, and encourage prospective recording of outcomes and recruitment of suitable patients. Patient summary: Focal therapy of prostate cancer is the targeted destruction of cancer within a specific part of the prostate gland, sparing the rest of the prostate and nearby tissue. This procedure could potentially reduce side effects when compared with established standard treatments, such as surgery or radiotherapy, which treat the entire prostate. Studies show that for most men with low-risk cancer, active surveillance is the preferred treatment option. However, the available data regarding all forms of focal therapy are still poor and inconclusive. Consequently, due to both the lack of clear results associated with focal therapy and the difficulties in detecting all cancerous areas of the prostate, focal therapy should be considered an investigational modality only. Focal therapy for localised prostate cancer may reduce morbidity of local therapy as well as be an alternative to active surveillance, provided that long-term data will show comparative oncological outcome.
KW - Focal therapy
KW - Index lesion
KW - Position paper
KW - Prostate cancer
UR - http://www.scopus.com/inward/record.url?scp=85040610113&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2018.01.001
DO - 10.1016/j.eururo.2018.01.001
M3 - Article
C2 - 29373215
SN - 0302-2838
VL - 74
SP - 84
EP - 91
JO - European Urology
JF - European Urology
IS - 1
ER -