Fokale Therapie des Prostatakarzinoms in Deutschland – Status 2014

[Focal therapy of prostate cancer in Germany]

BACKGROUND

Prostate cancer (PCa) is the most common cancer in men, which is increasingly diagnosed at a localized stage due to the widespread use of PSA (prostate-specific antigen)-screening.

METHOD

Traditionally, definite treatment options for PCa include radical prostatectomy, external beam radiotherapy, or brachytherapy. However, treatment-related side effects such as urinary incontinence and erectile dysfunction are common. Alternatively, national and international guidelines recommend active surveillance (AS) as a treatment option for low-risk PCa. Organ-preserving surgery is commonly used in other organs, such as organ-conserving surgery for breast cancer. Focal therapy (FT) for PCa may close the gap between radical treatment options and active surveillance while reducing side effects.

AIM

This article highlights the current therapy options for FT in Germany including their limitations and perspectives. Currently, different therapy options are available for FT in PCa. However, the use of FT is still embedded in clinical trials and has not been approved for routine use yet. Initial results seem to be promising, but most studies are currently enrolling or have not been published yet.

p53 family members - important messengers in cell death signaling in photodynamic therapy of cancer?

TP53 is one of the genes most frequently inactivated in cancers. Mutations in TP53 gene are linked to worse prognosis and shorter overall survival of cancer patients. TP53 encodes a critical tumor suppressor, which dictates cell fate decisions upon stress stimuli. As a sensor of cellular stress, p53 is a relevant messenger of cell death signaling in ROS-driven photodynamic therapy (PDT) of cancer. The significant role of p53 in response to PDT has been reported for several clinically approved photosensitizers. Multiple reports described that wild-type p53 contributes to cell killing upon photodynamic therapy with clinically approved photosensitizers but the mechanism is still not fully understood. This work outlines the diverse functions of p53 family members in cancer cells' susceptibility and resistance to PDT. In summary p53 and p53 family members are emerging as important mediators of cell death signaling in photodynamic therapy of cancer, however the mechanism of cell death provoked during PDT might differ depending on the tissue type and the photosensitizer applied.