San Diego, California (UroToday.com): Jean de la Rosette, MD emphasized that his objective is not about comparing active surveillance to focal/ablative therapy. His goal is identify a role for ablative therapy among other options.
The goal of ablative therapy is organ preservation. It is to ablative cancerous tissue within the body without harming surrounding structures. Current curative treatment has a negative QOL impact. There is a shift currently to low-risk and low stage prostate cancer.
Current options for treatment include prostatectomy, brachytherapy, EBRT and Active Surveillance. He states that one of the reasons patients choose AS is to avoid the negative consequences of a definitive treatment. He poses: “If they chose AS, are patients happy to do radical treatment?”
Focal treatment may be an alternative. It is feasible and safe. It avoids the burden of whole-gland treatment which includes over-treatment and avoidance of adverse effects (sexual, urinary and bowel morbidity). It also avoids burden of active surveillance (psychologic impact of knowing you have an untreated cancer and knowing you may “miss the opportunity for cure”). Additionally, focal ablation may be less costly than the follow-up costs for AS.
There are several different types of ablative treatment and not all are alike. Many are under investigation including cryoablation, photodynamic treatment, HIFU, and irreversible electroporation.
It may be oncologic safe if it is proven that no cancer exists in the region of ablation. However, PSA is not reliable after ablative therapy and may be difficult to follow. One needs a combination of MRI, PSA, and a repeat biopsy to ensure oncological safety.
Dr. Jean de la Rosette concluded that focal therapy may provide the proper balance between two extreme approaches (whole-gland treatment versus active surveillance), may provide psychological relief by eliminating concer of cancer, and minimize treatment related side effects. However, close surveillance of residual tissue is still needed.
Presented By: Jean de la Rosette, MD