Focal therapy - prostate cancer treatment for the near future?
What is focal therapy of the prostate?
In some ways, prostate cancer treatment has fallen behind other cancers. Although robotic surgery is a less invasive way of removing the prostate than an open cut, we are still not at the stage of being able to target cancer cells or groups of cells, and leave behind other non-cancerous cells in the prostate. This focused, or focal, treatment could have advantages in that important nearby structures are less at risk of damage compared to an operation to remove the prostate.
One of the issues is that, for some men, prostate cancer can be a multi-focal disease, meaning that it can occur in multiple areas of the prostate. Others may just have one 'index' lesion that needs treating, and these people could be good candidates for focal treatment.
High quality imaging is key
The key is high quality imaging of the prostate. There have been steps in the right direction with the use of multiparametric MRI of the prostate- see
A well performed mpMRI read by an expert radiologist is a powerful tool in identifying areas of the prostate that need biopsy - see
Accurate biopsy is very important
If we can have accurate biopsy - see
here - and be confident that this is a true representation of the degree of prostate cancer present, then it is just a small step to say that we could apply treatment to a focused area of the prostate to reduce the side effects of treatment for some men. Ask your urologist if he or she offers software fusion biopsy of the prostate.
Potential avenues for focal prostate cancer treatment
Currently, there are various options for development of focal therapy:
- 1 - focal brachytherapy - see
here for more information about brachytherapy - which is essentially just brachytherapy applied to one side of the prostate
- 2 - High intensity focused ultrasound (HIFU) treatment. This has been used in the past to treat the whole prostate, and results were mixed. Although focal-HIFU is in theory a slightly different approach, a lot of work needs to be done before this could be an accepted treatment
- 3 - Focal laser ablation using photodynamic treatment. Here a compound is injected, which is taken up by abnormal cells in the prostate. A laser is fired that is specific for the compound, and the laser causes a reaction in the compound that kills the targeted cells. The idea is that normal cells are not affected
- 4 - Direct laser energy targeting of the abnormal area in the prostate. This is the simplest, most direct and elegant idea - the area that is known to be abnormal and cancerous (from the MRI and subsequent biopsy) is targeted directly by a laser fibre. This approach has been investigated and used by urologists at UCLA in the States, and may hold out promise for the future
As surgical treatments become more refined, we hope that an increasing number of patients will be offered focal treatments. It is important that your urologist is able to discuss and offer a range of treatment. Most important is that the treatment is the right one for you.