BERKELEY, CA (UroToday.com) - Our article highlights an important period in medicine where the role of MR imaging of the prostate is gaining therapeutic value with the rapid development and acceptance of image-guided focal therapies.
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As we discover more about the heterogeneous nature of prostate cancer and its clinical disease course, we see that multi-modal imaging (US, MRI, and CT) is a mainstay for the early management of the disease. With the emphasis in global health care shifting towards personalized medicine, more case-specific MR imaging as well as improved image-guided focal therapy options should become available to patients with localized prostate cancer. For a younger male with a highly localized disease, it may be suitable to ablate or focally-destroy a tumor. The goal would be to eliminate the tumor or to set the disease course back far enough that it may prevent clinical progression to metastatic disease. Early diagnosis and treatment becomes very important as a result. Further, focal therapy has the added benefit of possibly minimizing the side effects associated with more traditional approaches, such as impotency and incontinence, from prostatectomy, or negative effects from hormone deprivation and radiotherapy.
In such a rapidly evolving area of medicine, it is important that both health care providers as well as their patients stay up to date with the ongoing progress of current clinical trials and new FDA-approved methods of treatment. This can be difficult considering the large amount of on-going research in both the academic and the commercial setting. Regular updates on image-guided focal therapy are required as there are several active clinical trials which were mentioned at the time of this publication and several more studies which have since begun.
As a majority of these techniques are still in the early stages (FLA, IRE, etc.) improvements are expected, and studies on the efficacy of these focal guided therapies will soon surely follow. A study published in European Urology by Barret et al. looked at focal therapy morbidity rates in 106 patients. Treatments included high-intensity focused ultrasound, cryotherapy, targeted photodynamic therapy, and brachytherapy. The results were promising in that < 2% of patients had major complications (considered as Grade 3). The recent reports of initial safety and efficacy study on irreversible electroporation (IRE) by Valerio et al have also shown strong functional outcomes with minimal side effects (100% continence, 95% potency). A larger, multi-institutional study on IRE is also currently underway in Europe. In addition to IRE, a simple search on ClinicalTrials.gov for focal laser ablation shows a handful of studies currently recruiting patients for focal laser ablation in the United States and Europe. The National Cancer Institute (Bethesda, MD, USA) is expected to report results on a focal laser ablation study, which will include 2-year follow-up results. While focal therapy is certainly a promising aspect of prostate cancer management, due to the resources required for widespread implementation, it will be some time before these techniques are readily adopted and used in clinical practice outside of large institutions. For now, it is important to continue supporting such developments in image-guided focal therapy.
- Barret E, Ahallal Y, Sanchez-Salas R, et al Morbidity of focal therapy in the treatment of localized prostate cancer. Eur Urol. 2013 Apr; 63(4):618-22.
- Valerio M, Stricker PD, Ahmed HU, et al Initial assessment of safety and clinical feasibility of irreversible electroporation in the focal treatment of prostate cancer. Prostate Cancer Prostatic Dis. 2014 Dec;17(4):343-7.
- van den Bos W, de Bruin DM, Muller BG, et al The safety and efficacy of irreversible electroporation for the ablation of prostate cancer: a multicentre prospective human in vivo pilot study protocol. BMJ Open. 2014 Oct 29; 4(10):e006382.
- MR Image Guided Therapy in Prostate Cancer. http://clinicaltrials.gov/show/NCT01377753. National Cancer Institute. Accessed November 20, 2014
Sandeep Sankineni, MD and Baris Turkbey, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Molecular Imaging Program, NCI, NIH, Bethesda, Maryland USA