Focal therapy for localized prostate cancer: the “state of the art”


In a report on the UroToday web site, John Fortin, a prostate cancer patient who chose to have focal therapy himself a while ago, has reported on information presented at the 12th International Symposium on Focal Therapy and Imaging in Prostate and Kidney Cancer, which was held in Washington, DC, in February this year.

John’s report is something that should be read by any patient who is considering whether focal therapy might be “right” for him. Our current opinion is that the value of focal therapy is hard to justify in the majority of patients initially diagnosed with low-risk prostate cancer — and particularly very low-risk prostate cancer (as defined by the NCCN guidelines). It’s potential value in the management of both “favorable” and “unfavorable” intermediate-risk disease is much easier to justify. However, …

We still have very few long-term data that would allow us to tell whether any form of focal therapy has a true progression-free survival benefit in the management of localized prostate cancer comparable to other forms of management.

On the other hand, we were interested to see the report refer to the potential role of focal therapy in the management of men who showed initial signs of progression after some time on AS. This does seem to Prostate Cancer International to be a place where the risks and benefits of focal therapy might well outweigh the risks and benefits of whole gland therapy in appropriately selected patients … but we need better data to support this premise.

 

One Response

  1. Kudos to John for putting this report together … Thank you, Mr. F.

    Two other area where we increasingly see focal therapy regimes being used are: (a) in treatment on recurrence after surgery or radiation, and (b) for spot treatment of metastatic lesions. For example, Dr. Kwan at Mayo is recommending cryoablation for oligometastatic bone lesions that may already have been pre-treated by some form of spot radiation — either SBRT or IMRT.

    In this scenario, AnCan has urged patients to seek a second opinion before entering into cryotherapy treatment.

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