There are several prostate cancer ablative therapies with various energies. Data from an International Multidisciplinary Consensus publication,1 which included various focal therapy experts, showed the various focal therapy modalities used by these experts.
Table 1 – Focal therapy modalities:1
Dr. Sivaraman continued and elaborated on some of the data that has been published on the outcomes of various focal therapy modalities. A recently published review included only published studies with a minimum of 50 patients with Gleason group grade 2 or above, and with a follow-up of at least 18 months. Importantly, all men had to have a post-ablation biopsy. The outcomes examined included heterogeneity in post-procedure follow-up, % of recurrent cancer of group grade 2 or above, and % of patients who managed to avoid radical treatment.
Tables 2 and 3 demonstrate the main results for cryoablation and HIFU modality, respectively. Table 4 demonstrates the main results for additional energy modalities.
Table 2 – Cryoablation focal therapy modality:
Table 3 – HIFU focal therapy modality:
Table 4 – Other energies focal therapy modality:
Next, Dr. Sivaraman discussed the effects of focal therapy on sexual function. In a combined analysis of three prospective trials, the sexual function almost normalized similar to baseline levels, approximately one year after focal treatment (Figure 1). In a systematic review of 26 publications, despite significant heterogeneity in reporting, the overall sexual function was very good with complete recovery at one year.2
Figure 1- Comparison of IIEF measuring erectile function before and after focal therapy:
In conclusion, the cancer-specific recurrence-free survival of focal therapy after short and intermediate follow-up is quite impressive (70-93%), and the radical treatment-free rate is 77-98%. The complication rate is relatively low, and patients usually preserve excellent urinary function and retain their erectile function, with some needing PDE-5 inhibitors. Dr. Sivaraman believes that focal therapy is most likely appropriate for select patients with an MRI visible, biopsy concordant, small tumor volume.
Presented by: Arjun Sivaraman, MD, MBBS, MS, MCH, Assistant Professor of Surgery, Washington School of Medicine, Saint Louis, MO
Written by: Hanan Goldberg, MD, MSc, Assistant Professor, Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA @GoldbergHanan at the 2020 Society of Urologic Oncology Annual Meeting – December 2-5, 2020 – Washington, DC
- Lebastchi AH, George AK, Polascik TJ, et al. Standardized Nomenclature and Surveillance Methodologies After Focal Therapy and Partial Gland Ablation for Localized Prostate Cancer: An International Multidisciplinary Consensus. European urology 2020; 78(3): 371-8.
- Fallara G, Capogrosso P, Maggio P, et al. Erectile function after focal therapy for localized prostate cancer: a systematic review. International Journal of Impotence Research 2020.