Buenos Aires, Argentina (UroToday.com) Scott Eggener, Professor University of Chicago, discussed use of focal therapy in prostate cancer. While PSA have decreased mortality, there are concerns regarding over diagnosis and over treatment of prostate cancer.
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With improved biomarkers and imaging including MRI, focal therapy may help over treatment and preserve QOL. Multifocality, lack of definitive follow-up protocol and lack of long term efficacy are concerns regarding use of focal therapy options. The case example for focal therapy is a man with an index, solitary lesion and intermediate risk disease. Potential follow-up may include postablation MRI, target biopsy plus standard at follow-up and consider retreatment based on the aforementioned. There are several clinical trials (153 to date) assessing utility of focal therapy for prostate cancer including MR ablation with preliminary data suggesting minimal morbidity and preserved QOL with short term acceptable oncologic outcomes. Photodynamic therapy is an additional modality which has preliminary acceptable outcomes regarding disease progression, radical treatment and positive post treatment biopsy over active surveillance in a randomized trial (manuscript in preparation).
Markus Graefen, Professor University of Hamburg-Eppendorf at the Martini Clinic, presented why focal therapy may be unsuitable treatment for men with immediate risk disease. There are lack of defined protocols following these patients after focal therapy and potential to undertreat unrecognized areas via current imaging modalities. Biochemical recurrence definitions are an issue as well as standard post treatment biopsy schematics including targeted, standard or combination of both biopsies. In a recent study 73/74 patients had residual cancer at salvage prostatectomy following HIFU with mutli foci found in 50-80%. A majority of these cancers were identified outside of the treatment zone which the zone has now been recommended with a 9mm treatment border.
In summary, focal therapy is here and further long term data regarding oncologic efficacy, QOL and associated costs of treatment are needed prior to determining if these treatments are suitable replacements to other guideline recommended treatments. Cost effectiveness research are lacking and comparative effectiveness research are needed to compare these modalities to conventional therapies. As of now, use of focal therapy should only be administered within the context of a clinical trial as suggested by the EAU guidelines.
World Urological Oncology Federation Symposium at the SIU Congress 2016 - October 20 - 23, 2016 – Buenos Aires, Argentina
Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.