Scott E. Eggener, Peter T. Scardino, Peter R. Carroll, Michael J. Zelefsky, Oliver Sartor, Hedvig Hricak, Thomas M. Wheeler, Samson W. Fine, John Trachtenberg, Mark A. Rubin, Mak Ohori, Kentaro Kuroiwa, Michel Rossignol, Lucien Abenhaim and International Task Force on Prostate Cancer and the Focal Lesion Paradigm has published a paper in the Journal of Urology. Below is part of the abstract.
In regions with a high prevalence of prostate specific antigen screening the over detection and subsequent overtreatment of prostate cancer is common. The incidence of unifocal cancers in radical prostatectomy specimens is 13% to 38%. In many others there is an index lesion with secondary foci containing pathological features similar to those found incidentally at autopsy. Because biopsy strategies and imaging techniques can provide more precise tumor localization and characterization, there is growing interest in focal therapy targeting unifocal or biologically unifocal tumors. The major arguments against focal therapy are multifocality, limited accuracy of staging, the unpredictable aggressiveness of secondary foci and the lack of established technology for focal ablation. Emerging technologies with the potential for focal therapy include high intensity focused ultrasound, cryotherapy, radio frequency ablation and photodynamic therapy.
Early detection of prostate cancer has led to concerns that while many cancers now diagnosed pose too little a threat for radical therapy, many men are reluctant to accept watchful waiting or active surveillance. Several emerging technologies seem capable of focal destruction of prostate tissue with minimal morbidity. We encourage the investigation of focal therapy in select men with low risk prostate cancer in prospective clinical trials that carefully document safety, functional outcomes and cancer control.
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