San Antonio, Texas USA (UroToday.com) Jonathan Coleman, Memorial Sloan Kettering Cancer Center, discussed recent trials in prostate partial gland ablation (PGA). While not approved by the FDA they are being done in the USA, however, they should be performed in the context of a clinical trial.
PGA offers opportunity for cancer control with minimal side effects and preserving quality of life (QOL). Current trial designs lack standardized measures for efficacy including study endpoints. Patients included may range from active surveillance candidates to those with metastatic disease for palliative reasons. At MSKCC, PGA candidates under MRI with re-biopsy confirming low volume with lower risk disease to undergo PGA with re-biopsy in 6 months. The FDA has regulations for prostate ablation. Devices must be safe with energies ranging from thermal, mechanical, chemical and biologics. In one of the first trials published regarding HIFU in 2012, 95% of patients at re-biopsy had absence of clinically significant disease with excellent QOL. Focal laser ablation results have shown similar results with 11% positive re-biopsy in the treated zone with lack of major toxicities. Irreversible electroporation involves disruption of cell membranes with preliminary phase I/II trial findings demonstrating safety. WST-11 (TOOKAD) is light activated chlorophil which releases free radicals in tissues with subsequent necrosis. Trial results have also demonstrated safety. Phase III trial comparing active surveillance to those treated with TOOKAD with significantly decreased progression among those treated with TOOKAD.
Presented by: Jonathan Coleman, Memorial Sloan Kettering Cancer Center
Written By: Stephen B. Williams, MD and Ashish M. Kamat
17th Annual Meeting of the Society of Urologic Oncology - November 30 -December 2, 2016 – San Antonio, Texas USA