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Babalola O, Gebben D, Tarver ME, Joyce Lee TH, Wang S, Siddiqui MM, Sonn GA, Viviano CJ. Patient Preferences for Benefit and Risk Associated With High Intensity Focused Ultrasound for the Ablation of Prostate Tissue in Men With Localized Prostate Cancer. Clin Genitourin Cancer 2024; 22:102113. [PMID: 38845330 DOI: 10.1016/j.clgc.2024.102113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 06/19/2024]
Abstract
INTRODUCTION Food and Drug Administration must make decisions about emerging high intensity focused ultrasound (HIFU) devices that may lack relevant clinical oncologic data but present with known side effects. This study aims to capture patients' perspective by quantifying their preferences regarding the available benefit and important side effects associated with HIFU for localized prostate cancer. MATERIALS AND METHODS Preferences for HIFU outcomes were examined using a discrete choice experiment survey. Participants were asked to choose a preferred treatment option in 9 choice questions. Each included a pair of hypothetical treatment profiles that have similar attributes/outcomes with varying levels. Outcomes included prostate biopsy outcome and treatment-related risks of erectile dysfunction (ED) and urinary incontinence (UI). We calculated the maximum risk of side effect patients were willing to tolerate in exchange for increased benefit. Preferences were further explored via clinical and demographic data. RESULTS About 223 subjects with a mean age of 64.8 years completed the survey. Respondents were willing to accept a 1.51%-point increase in new ED risk for a 1%-point increase in favorable biopsy outcome. They were also willing to accept a 0.93%-point increase in new UI risk for a 1%-point increase in biopsy outcome. Subjects who perceived their cancer to be more aggressive had higher risk tolerance for UI. Younger men were willing to tolerate less ED risk than older men. Respondents with greater than college level of education had a lower risk tolerance for ED or UI. CONCLUSIONS Results may inform development and regulatory evaluation for future HIFU ablation devices by providing supplemental information from the patient perspective.
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Affiliation(s)
- Olufemi Babalola
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, USA.
| | - David Gebben
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Michelle E Tarver
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ting-Hsuan Joyce Lee
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Shu Wang
- Department of Urology, University of Maryland Urology, Baltimore, Maryland, USA
| | - M Minhaj Siddiqui
- Department of Urology, University of Maryland Urology, Baltimore, Maryland, USA
| | - Geoffrey A Sonn
- Department of Urology, Stanford School of Medicine, Palo Alto, California, USA
| | - Charles J Viviano
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, USA
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Chinenov DV, Shpot EV, Chernov YN, Gerasimov AN, Kazachevskaya LY, Lyapichev KA, Ismailov HM, Tsukkiev ZK, Korolev DO, Rapoport LM. Evaluation of functional and oncological outcomes of localized prostate cancer after different minimally invasive therapeutic methods: A single center experience. Urologia 2024; 91:311-319. [PMID: 38247121 DOI: 10.1177/03915603231226366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVES To study the functional and oncological results of minimally invasive treatment methods: cryoablation, brachytherapy, and high-intensity focused ultrasound (HIFU) therapy of localized prostate cancer in a single hospital. METHODS One hundred sixty patients with localized prostate cancer were treated with minimally invasive methods (53, 52, 55 patients with cryoablation, brachytherapy and HIFU therapy, respectively). Prostate-specific antigen and evaluation of post-procedure biopsies were used as an assessment. The review of functional indicators and quality of life was made with International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL) questionnaires. RESULTS Patients after cryoablation showed worse results of oncological control according to positive repeat biopsies, best indicators were observed after brachytherapy. When considering the IPSS results, there were statistically significantly worse scores in the brachytherapy group in the early postoperative period, these differences do not reach statistical significance in the late period in the brachytherapy and cryoablation groups. Patients in the cryoablation group showed worse indicators of IIEF-5; in the early postoperative period; in the late follow-up period, the indicators of erectile function in patients in the cryoablation group did not statistically significantly differ from those in patients after brachytherapy. Patients after HIFU therapy showed fewer cases of de novo erectile dysfunction during the follow-up period of 3 years, higher average IIEF-5 scores, lower IPSS scores and better QoL results. CONCLUSION The recurrence of prostate cancer was statistically significantly higher in the International Society of Urological Pathology (ISUP) 3 grade group. HIFU therapy had better urination indicators compared to other groups, that can be associated with the laser enucleation of prostatic hyperplasia. The advantage was noted in patients after HIFU therapy when comparing the parameters to the IIEF-5 thus, HIFU treatment had a better impact on patients' QoL with localized prostate cancer.
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Affiliation(s)
- D V Chinenov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - E V Shpot
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Y N Chernov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - A N Gerasimov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - L Y Kazachevskaya
- The Pathology Residency Program at Louisiana State University Health Sciences Center in Shreveport, LA, USA
| | - K A Lyapichev
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - H M Ismailov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Z K Tsukkiev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - D O Korolev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - L M Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Nicoletti R, Alberti A, Castellani D, Yee CH, Zhang K, Poon DMC, Chiu PKF, Campi R, Resta GR, Dibilio E, Pirola GM, Chiacchio G, Fuligni D, Brocca C, Giulioni C, De Stefano V, Serni S, Gauhar V, Ng CF, Gacci M, Teoh JYC. Oncological results and cancer control definition in focal therapy for Prostate Cancer: a systematic review. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00699-7. [PMID: 37507479 DOI: 10.1038/s41391-023-00699-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Focal therapy (FT) is a promising alternative to whole-gland treatments for Localized Prostate Cancer. Ten different FT modalities have been described in literature. However, FT is not yet recommended by the International Guidelines, due to the lack of robust data on Oncological Outcomes. The objective of our Narrative Review is to evaluate the oncological profile of the available FT modalities and to offer a comprehensive overview of the definitions of Cancer Control for FT. MATERIAL AND METHODS Literature search was performed on 21st February 2023 using PubMed, EMBASE, and Scopus, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Articles reporting whole gland-treatments were excluded. All articles reporting oncological outcomes were included. RESULTS One-hundred-twenty-four studies, reporting data on more than 8000 patients treated with FT, were included. Overall, 40 papers were on High Intensity Focal Ultrasound (HIFU), 24 on Focal Cryotherapy, 13 on Irreversible Electroporation (IRE), 11 on Focal brachytherapy, 10 on Focal Laser Ablation (FLA), 8 on Photo-Dynamic Therapy (PDT), 3 on Microwave ablation, 3 on Robotic Partial Prostatectomy, 2 on bipolar Radio Frequency Ablation (bRFA), 1 on Prostatic Artery Embolization (PAE) and 9 comparative papers. Overall, the Biochemical Recurrence (BCR) rate ranged from 0% (Focal Brachytherapy) to 67.5% (HIFU); the Salvage treatment rate ranged from 1% (IRE) to 54% (HIFU) considering re-treatment with FT and from 0% (Focal Brachytherapy) to 66.7% considering standard Radical Treatments. There is no univocal definition of Cancer Control, however the "Phoenix criteria" for BCR were the most commonly used. CONCLUSIONS FT is a promising alternative treatment for localized prostate cancer in terms of Oncological Outcomes, however there is a wide heterogeneity in the definition of cancer control, the reporting of oncological outcomes and a lack of high-quality clinical trials. Solid comparative studies with standard treatments and an unambiguous consensus on how to describe Cancer Control in the field of Focal Therapy are needed.
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Affiliation(s)
- Rossella Nicoletti
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrea Alberti
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Daniele Castellani
- Urology Division, Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Chi Hang Yee
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai Zhang
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing, 100015, China
| | - Darren M C Poon
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Ka-Fung Chiu
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Giulio Raffaele Resta
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Edoardo Dibilio
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | | | - Giuseppe Chiacchio
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Demetra Fuligni
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Brocca
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Giulioni
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Virgilio De Stefano
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Vineet Gauhar
- Ng Teng Fong General Hospital (NUHS), Singapore, Singapore
| | - Chi Fai Ng
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Jeremy Yuen Chun Teoh
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
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4
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Selvaggio O, Finati M, Falagario UG, Silecchia G, Recchia M, Checchia AA, Milillo P, Sanguedolce F, Cindolo L, Busetto GM, Bettocchi C, Cormio L, Carrieri G. Treatment of localized prostate cancer in elderly patients: the role of partial cryoablation. Int Urol Nephrol 2023; 55:1125-1132. [PMID: 36809642 PMCID: PMC10105669 DOI: 10.1007/s11255-023-03519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To evaluate oncological outcomes of partial gland cryoablation (PGC) for localized prostate cancer (PCa) in a cohort of elderly patients who required an active treatment. METHODS Data from 110 consecutive patients treated with PGC for localized PCa were collected. All patients underwent the same standardized follow-up with serum-PSA level and digital rectal examination. Prostate MRI and eventual re-biopsy were performed at twelve months after cryotherapy or in case of suspicion of recurrence. Biochemical recurrence was defined according to Phoenix criteria (PSA nadir + 2 ng/ml). Kaplan-Meier curves and Multivariable Cox Regression analyses were used to predict disease progression, biochemical recurrence- (BCS) and additional treatment-free survival (TFS). RESULTS Median age was 75 years (IQR 70-79). PGC was performed in 54 (49.1%) patients with low-risk PCa, 42 (38.1%) with intermediate risk and 14 (12.8%) high risk. At a median follow-up of 36 months, we recorded a BCS and TFS of 75 and 81%, respectively. At 5 years, BCS was 68.5% and CRS 71.5%. High-risk prostate cancer was associated with lower TFS and BCS curves when compared with low-risk group (all p values < .03). A PSA reduction < 50% between preoperative level and nadir resulted as an independent failure predictor for all outcomes evaluated (all p values < .01). Age was not associated with worse outcomes. CONCLUSIONS PGC could be a valid treatment for low- to intermediate PCa in elderly patients, when a curative approach is suitable in terms of life expectancy and quality of life.
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Affiliation(s)
- Oscar Selvaggio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Marco Finati
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy. .,Department of Urology and Renal Transplantation, University of Foggia, Viale Pinto 1, 71110, Foggia, Italy.
| | | | - Giovanni Silecchia
- Department of Urology, Bonomo Teaching Hospital, Andria (BAT), Andria, Italy
| | - Marco Recchia
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | | | - Paola Milillo
- Department of Diagnostic Imaging, University of Foggia, Foggia, Italy
| | | | - Luca Cindolo
- Department of Urology, "Villa Stuart" Private Hospital, Rome, Italy
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Carlo Bettocchi
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.,Department of Urology, Bonomo Teaching Hospital, Andria (BAT), Andria, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
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5
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Alternative- and focal therapy trends for prostate cancer: a total population analysis of in-patient treatments in Germany from 2006 to 2019. World J Urol 2022; 40:1645-1652. [PMID: 35562598 PMCID: PMC9236973 DOI: 10.1007/s00345-022-04024-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/22/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Focal therapy (FT) offers an alternative approach for prostate cancer (PCa) treatment in selected patients. However, little is known on its actual establishment in health care reality. Patients and methods We defined FT as high-intensity focused ultrasound (HIFU), hyperthermia ablation, cryotherapy, transurethral ultrasound ablation (TULSA) or vascular-targeted photodynamic therapy (VTP) TOOKAD®. We analyzed the nationwide German hospital billing database for a PCa diagnosis in combination with FT. For analyses on the hospital level, we used the reimbursement.INFO tool based on hospitals’ quality reports. The study period was 2006 to 2019. Results We identified 23,677 cases of FT from 2006 to 2019. Considering all PCa cases with surgery, radiotherapy or FT, the share of FT was stable at 4%. The annual caseload of FT increased to a maximum of 2653 cases in 2008 (p < 0.001) and then decreased to 1182 cases in 2014 (p < 0.001). Since 2015, the cases of FT remained on a plateau around 1400 cases per year. The share of HIFU was stable at 92–96% from 2006 to 2017 and decreased thereafter to 75% in 2019 (p = 0.015). In 2019, VTP-TOOKAD® increased to 11.5% and TULSA to 6%. In 2006, 21% (62/299) of urological departments performed FT and 20 departments reached > 20 FT procedures. In 2019, 16% (58/368) of urological departments performed FT and 7 departments reached > 20 FT. In 2019, 25 urological departments offered FT other than HIFU: 5 centers hyperthermia ablation, 11 centers VTP TOOKAD®, 3 centers cryotherapy, 6 centers TULSA. Conclusion The FT development in Germany followed the Gartner hype cycle. While HIFU treatment is the most commonly performed FT, the share of newer FT modalities such as VTP-TOOKAD® and TULSA is remarkably increasing. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-04024-0.
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6
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Abrams LR, Koch MO, Bahler CD. Focal High-Intensity Focused Ultrasound Ablation of the Prostate. J Endourol 2021; 35:S24-S32. [PMID: 34499554 DOI: 10.1089/end.2020.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
With the advancement of early detection tools for prostate cancer and ability to better localize disease, there has been increased interest in focal or targeted therapies that carry less morbidity than traditional whole-gland treatments. The Sonablate® high-intensity focused ultrasound (HIFU) device has Food and Drug Administration (FDA) 510(K) clearance in the United States for ablation of prostate tissue. HIFU utilizes an ultrasound (US) transducer that focuses US beams on a preset point as much as 4 cm from the energy source without injuring intervening tissue. The Sonablate system guides the surgeon step-by-step to perform effective ablation of a target lesion. The surgeon can assess treatment effect with tissue change monitoring, and care is taken to prevent rectal wall injury. We believe hemiablation is the most favorable focal HIFU treatment to optimize cancer control and minimize the side effects associated with whole gland therapy. We recommend considering HIFU ablation as an extension of active surveillance rather than definitive treatment. Further research on long-term oncologic and functional outcomes is warranted.
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Affiliation(s)
- Lauren R Abrams
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael O Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Clinton D Bahler
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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7
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Sivaraman A, Marra G, Stabile A, Mombet A, Macek P, Lanz C, Cathala N, Moschini M, Carneiro A, Sanchez-Salas R, Cathelineau X. Does mpMRI guidance improve HIFU partial gland ablation compared to conventional ultrasound guidance? Early functional outcomes and complications from a single center. Int Braz J Urol 2021; 46:984-992. [PMID: 32822127 PMCID: PMC7527093 DOI: 10.1590/s1677-5538.ibju.2019.0682] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background Focal therapy (FT) for localized prostate cancer (PCa) treatment is raising interest. New technological mpMRI-US guided FT devices have never been compared with the previous generation of ultrasound-only guided devices. Materials and Methods We retrospectively analyzed prospectively recorded data of men undergoing FT for localized low- or intermediate-risk PCa with US- (Ablatherm®-2009 to 2014) or mpMRI-US (Focal One®-from 2014) guided HIFU. Follow-up visits and data were collected using internationally validated questionnaires at 1, 2, 3, 6 and 12 months. Results We included n=88 US-guided FT HIFU and n=52 mpMRI-US guided FT HIFU respectively. No major baseline differences were present except higher rates of Gleason 3+4 for the mpMRI-US group. No major differences were present in hospital stay (p=0.1), catheterization time (p=0.5) and complications (p=0.2) although these tended to be lower in the mpMRI-US group (6.8% versus 13.2% US FT group). At 3 months mpMRI-US guided HIFU had significantly lower urine leak (5.1% vs. 15.9%, p=0.04) and a lower drop in IIEF scores (2 vs. 4.2, p=0.07). Of those undergoing 12-months control biopsy in the mpMRI-US-guided HIFU group, 26% had residual cancer in the treated lobe. Conclusion HIFU FT guided by MRI-US fusion may allow improved functional outcomes and fewer complications compared to US- guided HIFU FT alone. Further analysis is needed to confirm benefits of mpMRI implementation at a longer follow-up and on a larger cohort of patients.
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Affiliation(s)
- Arjun Sivaraman
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Giancarlo Marra
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.,Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Armando Stabile
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Annick Mombet
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Petr Macek
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Camille Lanz
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Nathalie Cathala
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Marco Moschini
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Arie Carneiro
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
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8
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Cryoablation, high-intensity focused ultrasound, irreversible electroporation, and vascular-targeted photodynamic therapy for prostate cancer: a systemic review and meta-analysis. Int J Clin Oncol 2021; 26:461-484. [PMID: 33387088 DOI: 10.1007/s10147-020-01847-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
Cryoablation (CA), high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE), and vascular-targeted photodynamic therapy (VTP) have been evaluated as novel strategies for selected patients with prostate cancer (PCa). We aim to determine the current status of literature regarding the clinical outcomes among these minimally invasive therapies. A systematic search of PubMed, EMBASE, and the Cochrane Library for all English literature published from January 2001 to December 2019 was conducted to identify studies evaluating outcomes of CA, HIFU, IRE or VTP on PCa. Proportionality with 95% confidence intervals (CIs) was performed using STATA version 14.0. 56 studies consisting of 7383 participants were found to report data of interest and fulfilled the inclusion criteria in the final meta-analysis. The pooled proportions of positive biopsy after procedure were 20.0%, 24.3%, 24.2%, and 36.2% in CA, HIFU, IRE and VTP, respectively. The pooled proportions of BRFS were 75.7% for CA and 74.4% for HIFU. The pooled proportions of CSS were 96.1%, 98.2%, and 97.9% for CA, HIFU, and IRE, respectively. The pooled proportions of OS were 92.8% for CA and 85.2% for HIFU. The pooled proportions of FFS were 64.7%, 90.4%, and 76.7% for CA, IRE and VTP, respectively. The pooled proportions of MFS were 92.8% for HIFU and 99.1% for IRE. This meta-analysis shows that CA, HIFU, IRE, and VTP are promising therapies for PCa patients with similar clinical outcomes. However, further larger, well-designed randomized controlled trials are required to confirm this assertion.
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9
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Abstract
PURPOSE OF REVIEW Prostate focal therapy has the potential to preserve urinary and sexual function while eliminating clinically significant cancer in a subset of men with low-volume, organ-confined prostate cancer. This systematic review aims to examine current evidence to determine the efficacy and safety of focal therapy for standard clinical application. RECENT FINDINGS Focal therapy reduces the rate of cancer progression and conversion to radical therapy in men on active surveillance for prostate cancer. As a strategy, success in focal therapy is heavily dependent on the use of imaging and targeted biopsies. Despite advances in these areas, there remains a small but significant risk of under-detecting clinically significant cancer. Similarly, under-estimation of tumor volume may contribute to infield recurrences and close attention must be paid to the ablation margin. Although long-term oncological outcomes remain lacking, focal therapy has a low complication rate, minimal impact on urinary continence and a moderate impact on erectile function. SUMMARY With the appropriate expertise in imaging, targeted biopsy and targeted ablation, focal therapy is a good option in men with low-intermediate risk cancer who are willing to maximize their urinary and sexual function. However, close posttreatment surveillance and the possibility of conversion to whole gland therapy must be accepted.
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10
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Bénard A, Duroux T, Robert G. Cost-utility analysis of focal high-intensity focussed ultrasound vs active surveillance for low- to intermediate-risk prostate cancer using a Markov multi-state model. BJU Int 2019; 124:962-971. [PMID: 31298775 DOI: 10.1111/bju.14867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To estimate the relative cost-effectiveness of focal high-intensity focussed ultrasound (F-HIFU) compared to active surveillance (AS) in patients with low- to intermediate-risk prostate cancer, in France. PATIENTS AND METHODS A Markov multi-state model was elaborated for this purpose. Our analyses were conducted from the French National Health Insurance perspective, with a time horizon of 10 years and a 4% discount rate for cost and effectiveness. A secondary analysis used a 30-year time horizon. Costs are presented in 2016 Euros (€), and effectiveness is expressed as quality-adjusted life years (QALYs). Model parameters' value (probabilities for transitions between health states, and cost and utility of health states) is supported by systematic literature reviews (PubMed) and random effect meta-analyses. The cost of F-HIFU in our model was the temporary tariff attributed by the French Ministry of Health to the overall treatment of prostate cancer by HIFU (€6047). Our model was analysed using Microsoft Excel 2010 (Microsoft Corp., Redmond, WA, USA). Uncertainty about the value of the model parameters was handled through probabilistic analyses. RESULTS The five health states of our model were as follows: initial state (AS or F-HIFU), radical prostatectomy, radiation therapy, metastasis, and death. Transition probabilities from the initial F-HIFU state relied on four articles eligible for our meta-analyses. All were non-comparative studies. Utilities relied on a single cohort in San Diego, CA, USA. For a fictive cohort of 1000 individuals followed for 10 years, F-HIFU would be €207 520 more costly and would yield 382 less QALYs than AS, which means that AS is cost-effective when compared to F-HIFU. For a threshold value varying from €0 to 100 000/QALY, the probability of AS being cost-effective compared to F-HIFU varied from 56.5% to 60%. This level of uncertainty was in the same range with a 30-year time horizon. CONCLUSION Given existing published data, our results suggest that AS is cost-effective compared to F-HIFU in patients with low- and intermediate-risk prostate cancer, but with high uncertainty. This uncertainty must be scaled down by continuing to supply the model with new published data and ideally through a randomised clinical trial that includes cost-effectiveness analyses.
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Affiliation(s)
- Antoine Bénard
- Univ. Bordeaux, Inserm, UMR 1219, Bordeaux Population Health Research Center, Team EMOS, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service d'information Médicale, USMR & CIC-EC 14-01, Bordeaux, France
| | - Thomas Duroux
- Univ. Bordeaux, Inserm, UMR 1219, Bordeaux Population Health Research Center, Team EMOS, Bordeaux, France
| | - Grégoire Robert
- CHU de Bordeaux, Service d'urologie Andrologie et Transplantation Rénale, Université de Bordeaux, Bordeaux, France
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11
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Arnouil N, Gelet A, Matillon X, Rouviere O, Colombel M, Ruffion A, Mège-Lechevallier F, Subtil F, Badet L, Crouzet S. [Focal HIFU vs robot-assisted total prostatectomy: Functionnal and oncologic outcomes at one year]. Prog Urol 2018; 28:603-610. [PMID: 30243461 DOI: 10.1016/j.purol.2018.07.285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyse the functional and oncologic outcomes at one year of focal therapy with HIFU compared with total prostatectomy in patients with localised prostate cancer (PCa). PATIENTS AND METHODS Retrospective and monocentric study from 2008 to 2014 comparing 2 cohorts of patients with localised PCa (T1/T2 clinical stage, Gleason score≤3+4=7 and PSA<15ng/mL), one treated by focal therapy (HIFU-F group), one by robot-assisted total prostatectomy (RATP group). Primary outcome was a trifecta defined as: absence of urinary incontinence, erectile function with sexual relations without treatment, negative PSA with negative surgical margins (RATP group) or negative biopsy cores (HIFU-F group). RESULTS The 53 patients included in the "HIFU-F" group and the 66 patients in the "RATP" group were similar in terms of preoperative PSA, D'Amico risk group, erectile function but were different in terms of age, prostatic volume, length of cancer, Gleason score. Complication rate was not different. In multivariate analyse with propensity score, "HIFU-F" group achieved a better trifecta score than "RATP" group (OR=8,3, p=0,005). CONCLUSION In case of low or intermediate risk localised PCa, "HIFU-F" group had better functional outcomes than initial learning curse "RATP" group, at one year. A long-term evaluation by a common endpoint is necessary to judge the oncological equivalence of both techniques. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- N Arnouil
- Service d'urologie et chirurgie de la transplantation, hospices Civils de Lyon, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
| | - A Gelet
- Service d'urologie et chirurgie de la transplantation, hospices Civils de Lyon, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - X Matillon
- Service d'urologie et chirurgie de la transplantation, hospices Civils de Lyon, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France; Inserm U1060, CarMeN Laboratory, université de Lyon, université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - O Rouviere
- Service de radiologie, hospices Civils de Lyon, hôpital Edouard-Herriot, Lyon, France
| | - M Colombel
- Service d'urologie et chirurgie de la transplantation, hospices Civils de Lyon, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - A Ruffion
- Service d'urologie, hospices Civils de Lyon, centre hospitalier Lyon-Sud, Pierre Bénite, France
| | - F Mège-Lechevallier
- Service d'anatomopathologie, hospices Civils de Lyon, hôpital Edouard-Herriot, Lyon, France
| | - F Subtil
- Service de biostatistique, laboratoire de biométrie et biologie évolutive UMR 5558, hospices civils de Lyon, université de Lyon, université Lyon 1, CNRS, Villeurbanne, France
| | - L Badet
- Service d'urologie et chirurgie de la transplantation, hospices Civils de Lyon, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - S Crouzet
- Service d'urologie et chirurgie de la transplantation, hospices Civils de Lyon, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
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12
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Albisinni S, Mélot C, Aoun F, Limani K, Peltier A, Rischmann P, van Velthoven R. Focal Treatment for Unilateral Prostate Cancer Using High-Intensity Focal Ultrasound: A Comprehensive Study of Pooled Data. J Endourol 2018; 32:797-804. [PMID: 29790383 DOI: 10.1089/end.2018.0130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Focal therapy for prostate cancer (PCa) remains experimental. Aim of the current study is to review available evidence and perform a pooled analysis exploring oncologic and functional results of high intensity focus ultrasound (HIFU) focal therapy for the treatment of unilateral PCa. METHODS The National Library of Medicine Database was searched for relevant articles. A wide search was performed, including the combination of following words: "HIFU," "prostate," "cancer," and "focal." Overall, 167 articles were reviewed. Of these, seven articles were identified and eligible for the pooled analysis. Data on HIFU hemiablation or focal prostate ablation, oncologic and functional results were pooled from these seven studies that included 366 men with unilateral PCa. RESULTS In the 366 analyzed cases, mean age was 67 years (95% confidence interval 66-69), and mean preoperative prostate-specific antigen was 6.4 ng/cc (5.5-7.4). Three studies included PCa up to Gleason 7 (3 + 4), three studies did include also Gleason 7 (4 + 3), whereas one study had no limitation in terms of Gleason score. Regarding early complications, low-grade Clavien-Dindo I-II were reported in 26% (16-37), whereas high-grade Clavien-Dindo ≥III were found in 3.8% (0-8.6). Analyzing oncologic outcomes mean follow-up was 26 months (23-31): at one year after HIFU, negative biopsy rate for clinically significant PCa was 87% (79-96), whereas salvage treatment-free survival rate was 92% (85-98). Regarding functional outcomes, reported potency rates were 74% (64-84), and continence 96% (91-100), although definitions of potency and continence were not homogenous across studies. CONCLUSIONS This pooled analysis of the results of focal HIFU treatment of PCa shows promising oncologic and functional outcomes. Well-selected patients may be candidates for such a conservative partial treatment of the gland. Well-designed trials are awaited to compare HIFU focal treatment with current standard of care.
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Affiliation(s)
- Simone Albisinni
- 1 Department of Urology, Jules Bordet Institute , Urology Clinics, Free University of Brussels, Brussels, Belgium .,2 Department of Urology, Erasme Hospital, Urology Clinics, Free University of Brussels , Brussels, Belgium
| | - Christian Mélot
- 3 Department of Emergency Medicine, Erasme Hospital, Urology Clinics, Free University of Brussels , Brussels, Belgium
| | - Fouad Aoun
- 1 Department of Urology, Jules Bordet Institute , Urology Clinics, Free University of Brussels, Brussels, Belgium
| | - Ksenija Limani
- 1 Department of Urology, Jules Bordet Institute , Urology Clinics, Free University of Brussels, Brussels, Belgium
| | - Alexandre Peltier
- 1 Department of Urology, Jules Bordet Institute , Urology Clinics, Free University of Brussels, Brussels, Belgium
| | | | - Roland van Velthoven
- 1 Department of Urology, Jules Bordet Institute , Urology Clinics, Free University of Brussels, Brussels, Belgium
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13
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Babalola O, Lee TH(J, Viviano CJ. Prostate Ablation Using High Intensity Focused Ultrasound: A Literature Review of the Potential Role for Patient Preference Information. J Urol 2018; 200:512-519. [DOI: 10.1016/j.juro.2018.04.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Olufemi Babalola
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Ting-Hsuan (Joyce) Lee
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Charles J. Viviano
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
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14
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Annoot A, Olivier J, Valtille P, Deken V, Leroy X, Puech P, Villers A. Extra-target low-risk prostate cancer: implications for focal high-intensity focused ultrasound of clinically significant prostate cancer. World J Urol 2018; 37:261-268. [DOI: 10.1007/s00345-018-2442-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
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15
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Calio B, Kasson M, Sugano D, Ortman M, Gaitonde K, Verma S, Sidana A. Multiparametric MRI: An Opportunity for Focal Therapy of Prostate Cancer. Semin Roentgenol 2018; 53:227-233. [DOI: 10.1053/j.ro.2018.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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16
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Ganzer R, Hadaschik B, Pahernik S, Koch D, Baumunk D, Kuru T, Heidenreich A, Stolzenburg JU, Schostak M, Blana A. Prospective Multicenter Phase II Study on Focal Therapy (Hemiablation) of the Prostate with High Intensity Focused Ultrasound. J Urol 2018; 199:983-989. [DOI: 10.1016/j.juro.2017.10.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Roman Ganzer
- Department of Urology, Asklepios Hospital Bad Tölz, Bad Tölz, Germany
- Department of Urology, University Hospital of Leipzig, Leipzig, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Urology, University Hospital of Essen, Essen, Germany
| | - Sascha Pahernik
- Department of Urology, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Daniel Koch
- Department of Urology, Fürth Hospital, Fürth, Germany
| | - Daniel Baumunk
- Department of Urology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Timur Kuru
- Department of Urology, University Hospital of Köln, Köln, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital of Köln, Köln, Germany
| | | | - Martin Schostak
- Department of Urology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Andreas Blana
- Department of Urology, Fürth Hospital, Fürth, Germany
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17
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Bloom JB, Gold SA, Hale GR, Rayn KN, Sabarwal VK, Bakhutashvili I, Valera V, Turkbey B, Pinto PA, Wood BJ. "Super-active surveillance": MRI ultrasound fusion biopsy and ablation for less invasive management of prostate cancer. Gland Surg 2018; 7:166-187. [PMID: 29770311 DOI: 10.21037/gs.2018.03.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Multiparametric magnetic resonance imaging (mpMRI) of the prostate has allowed clinicians to better visualize and target suspicious lesions during biopsy. Targeted prostate biopsies give a more accurate representation of the true cancer volume and stage so that appropriate treatment or active surveillance can be selected. Advances in technology have led to the development of MRI and ultrasound fusion platforms used for targeted biopsies, monitoring cancer progression, and more recently for the application of focal therapy. Lesions visualized on mpMRI can be targeted for ablation with a variety of energy sources employed under both local and general anesthesia. Focal ablation may offer an alternative option for treating prostate cancer as compared to the well-established interventions of whole-gland radiation or prostatectomy. Focal ablation may also be an option for patients on active surveillance who wish to be even more "active" in their surveillance. In this review, we describe the advancements and development of fusion biopsies, the rationale behind focal therapy, and introduce focal ablative techniques for indolent prostate cancers ("super-active surveillance"), including cryoablation and focal laser ablation (FLA) and the subsequent MRI/biopsy surveillance.
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Affiliation(s)
- Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Samuel A Gold
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Graham R Hale
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Kareem N Rayn
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Vikram K Sabarwal
- Department of Urology, George Washington University, Washington, DC, USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, National Cancer Institute, Bethesda, MD, USA
| | - Vladimir Valera
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, Bethesda, MD, USA
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18
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Elkhoury FF, Simopoulos DN, Marks LS. MR-guided biopsy and focal therapy: new options for prostate cancer management. Curr Opin Urol 2018; 28:93-101. [PMID: 29232269 PMCID: PMC7314431 DOI: 10.1097/mou.0000000000000471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Options for prostate cancer management are rapidly expanding. The recent advent of MRI technology has led to guided prostate biopsies by radiologists working in-bore or by urologists using MR/US fusion technology. The resulting tumor visualization now provides the option of focal therapy. Currently available are highly directed energies - focused ultrasound (HIFU), cryotherapy, and laser - all offering the hope of curing prostate cancer with few side effects. RECENT FINDINGS MRI now enables visualization of many prostate cancers. MR/US fusion biopsy makes possible the targeted biopsy of suspicious lesions efficiently in the urology clinic. Several fusion devices are now commercially available. Focal therapy, a derivative of targeted biopsy, is reshaping the approach to treatment of some prostate cancers. Focal laser ablation, originally done in the MRI gantry (in-bore), promises to soon become feasible in a clinic setting (out-of-bore) under local anesthesia. Other focal therapy options, including HIFU and cryotherapy, are currently available. Herein are summarized outcomes data on focal therapy modalities. SUMMARY MRI-guided biopsy is optimizing prostate cancer diagnosis. Focal therapy, an outgrowth of guided biopsy, promises to become a well tolerated and effective approach to treating many men with prostate cancer while minimizing the risks of incontinence and impotence from radical treatment.
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Affiliation(s)
- Fuad F. Elkhoury
- UCLA Department of Urology, David Geffen School of Medicine, Wasserman Bldg, Suite 331, UCLA Medical Plaza, Los Angeles, CA 90095, Phone: 310-794-8659, Fax: 310-794-8653
| | - Demetrios N. Simopoulos
- UCLA Department of Urology, David Geffen School of Medicine, Wasserman Bldg, Suite 331, UCLA Medical Plaza, Los Angeles, CA 90095, Phone: 310-794-8659, Fax: 310-794-8653
| | - Leonard S. Marks
- UCLA Department of Urology, David Geffen School of Medicine, Wasserman Bldg, Suite 331, UCLA Medical Plaza, Los Angeles, CA 90095, Phone: 310-794-8659, Fax: 310-794-8653
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19
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Winoker JS, Anastos H, Rastinehad AR. Targeted Ablative Therapies for Prostate Cancer. Cancer Treat Res 2018; 175:15-53. [PMID: 30168116 DOI: 10.1007/978-3-319-93339-9_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Men diagnosed with low- to intermediate-risk, clinically localized prostate cancer (PCa) often face a daunting and difficult decision with respect to treatment: active surveillance (AS) or radical therapy. This decision is further confounded by the fact that many of these men diagnosed, by an elevated PSA, will have indolent disease and never require intervention. Radical treatments, including radical prostatectomy and whole-gland radiation, offer greater certainty for cancer control, but at the risk of significant urinary and/or sexual morbidity. Conversely, AS preserves genitourinary function and quality of life in exchange for burdensome surveillance and the psychological impact of living with cancer.
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Affiliation(s)
- Jared S Winoker
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Harry Anastos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ardeshir R Rastinehad
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA. .,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA.
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20
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[FOCAL THERAPY WITH HIGH-INTENSITY FOCUSED ULTRASOUND FOR THE LOCALIZED PROSTATE CANCER BASED ON THE LOCALIZATION WITH MRI-TRUS FUSION IMAGE-GUIDED BIOPSY: 1-YEAR PROSPECTIVE STUDY]. Nihon Hinyokika Gakkai Zasshi 2018; 109:194-203. [PMID: 31631082 DOI: 10.5980/jpnjurol.109.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Objective) To evaluate the efficacy and invasiveness of focal therapy with transrectal high-intensity focused ultrasound (HIFU) for localized prostate cancer based on spatial location of significant cancer with magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion image-guided biopsy. (Methods) Patients with low- and intermediate-risk significant prostate cancer who were followed-up at least 1 year, were prospectively recruited. The spatial localization of the significant cancer was determined by MRI-TRUS fusion image-guided transperineal prostate biopsy. Focal therapy targeting the regions of significant cancer was performed by transrectal HIFU using a Sonablate® 500 (SonaCare Medical, Indianapolis, IN, USA). Serum prostate-specific antigen (PSA) kinetics, multi-parametric MRI, and MRI-TRUS fusion image-guided prostate biopsy were analyzed to determine the treatment efficacy. Questionnaires and uroflowmetry were performed to evaluate the invasiveness. (Results) Ten men with median age of 67 years (range, 48-79), median PSA level of 7.07 ng/ml (range, 4.67-15.99), median prostate volume of 25 ml (range, 19-36) were treated. Median operative time was 29.5 minutes (range, 14-85). Catheterization was performed within 24 hours after the treatment in all patients. The median PSA concentration significantly decreased to 1.35 ng/ml (p<0.0001) at 3 months after the treatment. Contrast-enhanced T1-weighted MRI showed the disappearance of blood flow in all targeted regions of the prostate. MRI-TRUS fusion image-guided prostate biopsy detected the significant cancer out of the treated region in 1 patient. In urinary function, residual urine was significantly increased at 3 months after the treatment (p=0.007), but improved to the preoperative level (p=0.411). There was no significant deterioration in IPSS, IPSS QOL, OABSS, and the urinary function domain of EPIC between before and 3, 6, 9, and 12 months after the treatment. In sexual function, there was no significant difference in IIEF-5 and the sexual domain of EPIC between before and 3, 6, 9, and 12 months after the treatment. In quality of life, there was no significant difference in EPIC and SF-36 between before and 3, 6, 9, and 12 months after the treatment. The proportion of men with erections sufficient for penetration and ejaculation remained unchanged at 100% (5 of 5 patients). No serious adverse events were recorded. (Conclusions) The focal therapy with HIFU has the potential to provide accurate treatment with low morbidity in patients with localized prostate cancer. Further large studies are required to investigate the effects of the focal therapy with HIFU for analysis of oncological and functional outcomes in patients with localized prostate cancer.
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21
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Matheus WE, Ferreira U. Focal therapy will be the next step on prostate cancer management? | Opinion: No. Int Braz J Urol 2017; 43:1017-1020. [PMID: 29206373 PMCID: PMC5734063 DOI: 10.1590/s1677-5538.ibju.2017.06.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Wagner Eduardo Matheus
- Departamento de Cirurgia, Departamento de Uro-oncologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil
| | - Ubirajara Ferreira
- Departamento Urologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
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22
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Tay KJ, Cheng CWS, Lau WKO, Khoo J, Thng CH, Kwek JW. Focal Therapy for Prostate Cancer with In-Bore MR–guided Focused Ultrasound: Two-Year Follow-up of a Phase I Trial—Complications and Functional Outcomes. Radiology 2017; 285:620-628. [DOI: 10.1148/radiol.2017161650] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Kae Jack Tay
- From the Department of Urology, Singapore General Hospital, Outram Rd, Singapore 169608 (K.J.T., C.W.S.C., W.K.O.L.); and Division of Oncologic Imaging, National Cancer Center, Singapore (J.K., C.H.T., J.W.K.)
| | - Christopher W. S. Cheng
- From the Department of Urology, Singapore General Hospital, Outram Rd, Singapore 169608 (K.J.T., C.W.S.C., W.K.O.L.); and Division of Oncologic Imaging, National Cancer Center, Singapore (J.K., C.H.T., J.W.K.)
| | - Weber K. O. Lau
- From the Department of Urology, Singapore General Hospital, Outram Rd, Singapore 169608 (K.J.T., C.W.S.C., W.K.O.L.); and Division of Oncologic Imaging, National Cancer Center, Singapore (J.K., C.H.T., J.W.K.)
| | - James Khoo
- From the Department of Urology, Singapore General Hospital, Outram Rd, Singapore 169608 (K.J.T., C.W.S.C., W.K.O.L.); and Division of Oncologic Imaging, National Cancer Center, Singapore (J.K., C.H.T., J.W.K.)
| | - Choon Hua Thng
- From the Department of Urology, Singapore General Hospital, Outram Rd, Singapore 169608 (K.J.T., C.W.S.C., W.K.O.L.); and Division of Oncologic Imaging, National Cancer Center, Singapore (J.K., C.H.T., J.W.K.)
| | - Jin Wei Kwek
- From the Department of Urology, Singapore General Hospital, Outram Rd, Singapore 169608 (K.J.T., C.W.S.C., W.K.O.L.); and Division of Oncologic Imaging, National Cancer Center, Singapore (J.K., C.H.T., J.W.K.)
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Abstract
The target of focal therapy (FT) in prostate cancer (PC) is partial treatment of the prostate aiming at preserving surrounding anatomical structures. The intention is to minimize typical side effects of radical treatment options combined with local tumor control. Numerous established and new technologies are used. Results of published studies showed a good safety profile, few side effects and good preservation of functional results. Oncologic long-term data are lacking so far. Photodynamic therapy (PDT) is the only technology that has been studied in a published prospective randomized trial. The FT is challenged by the multifocality of PC; therefore, the quality of prostate biopsy, histopathological assessment as well as imaging are of paramount importance. Multiparametric magnetic resonance imaging (MRI) has gained increasing importance. The FT is experimental and should only be offered within clinical trials.
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Golan R, Bernstein AN, McClure TD, Sedrakyan A, Patel NA, Parekh DJ, Marks LS, Hu JC. Partial Gland Treatment of Prostate Cancer Using High-Intensity Focused Ultrasound in the Primary and Salvage Settings: A Systematic Review. J Urol 2017; 198:1000-1009. [PMID: 28433640 DOI: 10.1016/j.juro.2017.03.137] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Advances in prostate imaging, biopsy and ablative technologies have been accompanied by growing enthusiasm for partial gland ablation, particularly using high-intensity focused ultrasound, to treat prostate cancer. Preserving noncancerous prostate tissue and minimizing damage to the neurovascular bundles and external urethral sphincter may improve functional outcomes. MATERIALS AND METHODS A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using a combination of MeSH® terms, free text search and examination of relevant bibliographies using MEDLINE® and Embase® from the inception of each database through October 10, 2016. We excluded studies describing exclusively whole gland ablation, case reports and series where treatment was followed by immediate resection. RESULTS A total of 13 studies that enrolled 543 patients were included. Of the studies 11 were performed in the primary setting and 2 in the salvage setting. Median followup ranged from 6 months to 10.6 years. Rates of posttreatment erectile dysfunction and urinary incontinence ranged from 0% to 48% and 0% to 50%, respectively, with definitions varying by study. Overall there were 254 reported complications. Marked heterogeneity between studies limited the ability to pool results regarding functional and oncologic outcomes. A total of 76 patients (14%) subsequently received further oncologic treatment. CONCLUSIONS Early evidence suggests that partial gland ablation is a safe treatment option for men with localized disease. Longer term data are needed to evaluate oncologic efficacy and functional outcomes, and will aid in identifying the optimal candidates for therapy. Standardization of outcomes definitions will allow for better comparison between studies and among treatment modalities.
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Affiliation(s)
- Ron Golan
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Adrien N Bernstein
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Timothy D McClure
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Neal A Patel
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Dipen J Parekh
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jim C Hu
- Department of Urology, Weill Cornell Medical College, New York, New York.
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25
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26
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Capogrosso P, Barret E. High-Intensity Focused Ultrasound. IMAGING AND FOCAL THERAPY OF EARLY PROSTATE CANCER 2017. [DOI: 10.1007/978-3-319-49911-6_24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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27
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Guillaumier S, Solomon E, Jenks J, Pakzad M, Hamid R, Ockrim J, Shah J, Greenwell T. Radiotherapy is associated with reduced continence outcomes following implantation of the artificial urinary sphincter in men with post-radical prostatectomy incontinence. Urol Ann 2017; 9:253-256. [PMID: 28794592 PMCID: PMC5532893 DOI: 10.4103/ua.ua_25_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: The objective of this study is to present the outcomes of men undergoing implantation of artificial urinary sphincter, after treatment for prostate cancer and also to determine the effect of radiotherapy on continence outcomes after artificial urinary sphincter (AUS) implantation. Materials and Methods: A prospectively acquired database of all 184 patients having AUS insertion between 2002 and 2012 was reviewed, and demographic data, mode of prostate cancer treatment(s) before implantation, and outcome in terms of complete continence (pad free, leak free) were assessed. Statistical analysis was performed by Chi-squared and Fisher's exact tests. Results: A total of 58 (32%) men had bulbar AUS for urodynamically proven stress urinary incontinence consequent to treatment for prostate cancer in this period. Median follow-up post-AUS activation was 19 months (1–119). Forty-eight (83%) men had primary AUS insertion. Twenty-one (36%) men had radiotherapy as part of or as their sole treatment. Success rates were significantly higher in nonirradiated men having primary sphincter (89%) than in irradiated men (56%). Success rates were worse for men having revision AUS (40%), especially in irradiated men (33%). Conclusion: Radiotherapy as a treatment for prostate cancer was associated with significantly lower complete continence rates following AUS implantation.
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Affiliation(s)
| | - Eskinder Solomon
- Department of Urology, University College London Hospital, London, W1G 8PH, UK
| | - Julie Jenks
- Department of Urology, University College London Hospital, London, W1G 8PH, UK
| | - Mahreen Pakzad
- Department of Urology, University College London Hospital, London, W1G 8PH, UK
| | - Rizwan Hamid
- Department of Urology, University College London Hospital, London, W1G 8PH, UK
| | - Jeremy Ockrim
- Department of Urology, University College London Hospital, London, W1G 8PH, UK
| | - Julian Shah
- Department of Urology, University College London Hospital, London, W1G 8PH, UK
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, W1G 8PH, UK
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New and Established Technology in Focal Ablation of the Prostate: A Systematic Review. Eur Urol 2017; 71:17-34. [PMID: 27595377 DOI: 10.1016/j.eururo.2016.08.044] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/18/2016] [Indexed: 11/22/2022]
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Perez-Reggeti JI, Sanchez-Salas R, Sivaraman A, Linares Espinos E, de Gracia-Nieto AE, Barret E, Galiano M, Rozet F, Fregeville A, Renard-Penna R, Cathala N, Mombet A, Prapotnich D, Cathelineau X. High intensity focused ultrasound with Focal-One ® device: Prostate-specific antigen impact and morbidity evaluation during the initial experience. Actas Urol Esp 2016; 40:608-614. [PMID: 27543259 DOI: 10.1016/j.acuro.2016.04.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We report our initial experience in the treatment of prostate cancer (PCa) with high-intensity focused ultrasound (HIFU) using the Focal-One® device. MATERIAL AND METHODS Retrospective review of the prospectively populated database. Between June 2014 to October 2015, 85 patients underwent HIFU (focal/whole-gland) treatment for localized PCa. Preoperative cancer localization was done with multiparametric magnetic resonance imaging (mpMRI) and transperineal mapping biopsies. Treatment was carried out using the Focal-One® device under general anesthesia. Oncological follow-up: PSA measurement and control biopsy with mpMRI according to protocol. Questionnaire-based functional outcome assessment was done. Complications were reported using Clavien classification. RESULTS The median PSA was 7.79ng/ml (IQR 6.32-9.16), with a median prostate volume of 38cc (IQR: 33-49.75). Focal and whole-gland therapy was performed in 64 and 21 patients respectively. Ten patients received salvage HIFU. Complications were encountered in 15% of cases, all Clavien 2 graded. Mean hospital stay was 1.8 days (0-7) and bladder catheter was removed on day 2 (1-6). Mean percentage reduction of PSA was 54%. Median follow-up was 3 months (IQR: 2-8). Functional outcomes: All patients were continents at 3 months and potency was maintained in 83% of the preoperatively potent. CONCLUSIONS Focal-One® HIFU treatment appears to be a safe procedure with few complications. Functional outcomes proved no urinary incontinence and sexual function were maintained in 83%.
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Affiliation(s)
- J I Perez-Reggeti
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - R Sanchez-Salas
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia.
| | - A Sivaraman
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - E Linares Espinos
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | | | - E Barret
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - M Galiano
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - F Rozet
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - A Fregeville
- Departamento de Radiología, Institut Mutualiste Montsouris, París, Francia
| | - R Renard-Penna
- Departamento de Radiología, Pitié-Salpêtrière Hospital, París, Francia
| | - N Cathala
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - A Mombet
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - D Prapotnich
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - X Cathelineau
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
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Perera M, Krishnananthan N, Lindner U, Lawrentschuk N. An update on focal therapy for prostate cancer. Nat Rev Urol 2016; 13:641-653. [DOI: 10.1038/nrurol.2016.177] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Jin CS, Overchuk M, Cui L, Wilson BC, Bristow RG, Chen J, Zheng G. Nanoparticle-Enabled Selective Destruction of Prostate Tumor Using MRI-Guided Focal Photothermal Therapy. Prostate 2016; 76:1169-81. [PMID: 27198587 DOI: 10.1002/pros.23203] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/27/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Magnetic Resonance Imaging (MRI)-guided focal laser therapy has shown early promise in Phase 1 trial treating low/intermediate-risk localized prostate cancer (PCa), but the lack of tumor selectivity and low efficiency of heat generation remain as drawbacks of agent-free laser therapy. Intrinsic multifunctional porphyrin-nanoparticles (porphysomes) have been exploited to treat localized PCa by MRI-guided focal photothermal therapy (PTT) with significantly improved efficiency and tumor selectivity over prior methods of PTT, providing an effective and safe alternative to active surveillance or radical therapy. METHODS The tumor accumulation of porphysomes chelated with copper-64 was determined and compared with the clinic standard (18) F-FDG in an orthotropic PCa mouse model by positron emission tomography (PET) imaging, providing quantitative assessment for PTT dosimetry. The PTT was conducted with MRI-guided light delivery and monitored by MR thermometry, mimicking the clinical protocol. The efficacy of treatment and adverse effects to surround tissues were evaluated by histology analysis and tumor growth in survival study via MRI. RESULTS Porphysomes showed superior tumor-to-prostate selectivity over (18) F-FDG (6:1 vs. 0.36:1). MR thermometry detected tumor temperature increased to ≥55°C within 2 min (671 nm at 500 mW), but minimal increase in surrounding tissues. Porphysome enabled effective PTT eradication of tumor without damaging adjacent organs in orthotropic PCa mouse model. CONCLUSIONS Porphysome-enabled MRI-guided focal PTT could be an effective and safe approach to treat PCa at low risk of progression, thus addressing the significant unmet clinical needs and benefiting an ever-growing number of patients who may be over-treated and risk unnecessary side effects from radical therapies. Prostate 76:1169-1181, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Cheng S Jin
- Princess Margaret Cancer Center, UHN, Toronto, Canada
- Faculty of Pharmacy, Department of Pharmaceutical Sciences, University of Toronto, Toronto, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Marta Overchuk
- Princess Margaret Cancer Center, UHN, Toronto, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Liyang Cui
- Princess Margaret Cancer Center, UHN, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
- Medical Isotopes Research Center, Peking University, Beijing, China
| | - Brian C Wilson
- Princess Margaret Cancer Center, UHN, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Robert G Bristow
- Princess Margaret Cancer Center, UHN, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Juan Chen
- Princess Margaret Cancer Center, UHN, Toronto, Canada
| | - Gang Zheng
- Princess Margaret Cancer Center, UHN, Toronto, Canada
- Faculty of Pharmacy, Department of Pharmaceutical Sciences, University of Toronto, Toronto, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
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Final Results of a Phase I/II Multicenter Trial of WST11 Vascular Targeted Photodynamic Therapy for Hemi-Ablation of the Prostate in Men with Unilateral Low Risk Prostate Cancer Performed in the United States. J Urol 2016; 196:1096-104. [PMID: 27291652 DOI: 10.1016/j.juro.2016.05.113] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Vascular targeted photodynamic therapy with WST11 (TOOKAD® Soluble) is a form of tissue ablation that may be used therapeutically for localized prostate cancer. To study dosing parameters and associated treatment effects we performed a prospective, multicenter, phase I/II trial of WST11 vascular targeted photodynamic therapy of prostate cancer. MATERIALS AND METHODS A total of 30 men with unilateral, low volume, Gleason 3 + 3 prostate cancer were enrolled at 5 centers after local institutional review board approval. Light energy, fiber number and WST11 dose were escalated to identify optimal dosing parameters for vascular targeted photodynamic therapy hemi-ablation. Men were treated with photodynamic therapy and evaluated by posttreatment magnetic resonance imaging and biopsy. Prostate specific antigen, light dose index (defined as fiber length/desired treatment volume), toxicity and quality of life parameters were recorded. RESULTS After dose escalation 21 men received optimized dosing of 4 mg/kg WST11 at 200 J energy. On posttreatment biopsy residual prostate cancer was found in the treated lobe in 10 men, the untreated lobe in 4 and both lobes in 1. At a light dose index of 1 or greater with optimal dosing in 15 men 73.3% had a negative biopsy in the treated lobe. Six men undergoing retreatment with the optimal dose and a light dose index of 1 or greater had a negative posttreatment biopsy. Minimal effects were observed on urinary and sexual function, and overall quality of life. CONCLUSIONS Hemi-ablation of the prostate with WST11 vascular targeted photodynamic therapy was well tolerated and resulted in a negative biopsy in the treated lobe in the majority of men. Dosing parameters and the light dose index appear related to tissue response as determined by magnetic resonance imaging and biopsy. These parameters may serve as the basis for further prospective studies.
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Ramsay CR, Adewuyi TE, Gray J, Hislop J, Shirley MDF, Jayakody S, MacLennan G, Fraser C, MacLennan S, Brazzelli M, N'Dow J, Pickard R, Robertson C, Rothnie K, Rushton SP, Vale L, Lam TB. Ablative therapy for people with localised prostate cancer: a systematic review and economic evaluation. Health Technol Assess 2016; 19:1-490. [PMID: 26140518 DOI: 10.3310/hta19490] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND For people with localised prostate cancer, active treatments are effective but have significant side effects. Minimally invasive treatments that destroy (or ablate) either the entire gland or the part of the prostate with cancer may be as effective and cause less side effects at an acceptable cost. Such therapies include cryotherapy, high-intensity focused ultrasound (HIFU) and brachytherapy, among others. OBJECTIVES This study aimed to determine the relative clinical effectiveness and cost-effectiveness of ablative therapies compared with radical prostatectomy (RP), external beam radiotherapy (EBRT) and active surveillance (AS) for primary treatment of localised prostate cancer, and compared with RP for salvage treatment of localised prostate cancer which has recurred after initial treatment with EBRT. DATA SOURCES MEDLINE (1946 to March week 3, 2013), MEDLINE In-Process & Other Non-Indexed Citations (29 March 2013), EMBASE (1974 to week 13, 2013), Bioscience Information Service (BIOSIS) (1956 to 1 April 2013), Science Citation Index (1970 to 1 April 2013), Cochrane Central Register of Controlled Trials (CENTRAL) (issue 3, 2013), Cochrane Database of Systematic Reviews (CDSR) (issue 3, 2013), Database of Abstracts of Reviews of Effects (DARE) (inception to March 2013) and Health Technology Assessment (HTA) (inception to March 2013) databases were searched. Costs were obtained from NHS sources. REVIEW METHODS Evidence was drawn from randomised controlled trials (RCTs) and non-RCTs, and from case series for the ablative procedures only, in people with localised prostate cancer. For primary therapy, the ablative therapies were cryotherapy, HIFU, brachytherapy and other ablative therapies. The comparators were AS, RP and EBRT. For salvage therapy, the ablative therapies were cryotherapy and HIFU. The comparator was RP. Outcomes were cancer related, adverse effects (functional and procedural) and quality of life. Two reviewers extracted data and carried out quality assessment. Meta-analysis used a Bayesian indirect mixed-treatment comparison. Data were incorporated into an individual simulation Markov model to estimate cost-effectiveness. RESULTS The searches identified 121 studies for inclusion in the review of patients undergoing primary treatment and nine studies for the review of salvage treatment. Cryotherapy [3995 patients; 14 case series, 1 RCT and 4 non-randomised comparative studies (NRCSs)], HIFU (4000 patients; 20 case series, 1 NRCS) and brachytherapy (26,129 patients; 2 RCTs, 38 NRCSs) studies provided limited data for meta-analyses. All studies were considered at high risk of bias. There was no robust evidence that mortality (4-year survival 93% for cryotherapy, 99% for HIFU, 91% for EBRT) or other cancer-specific outcomes differed between treatments. For functional and quality-of-life outcomes, the paucity of data prevented any definitive conclusions from being made, although data on incontinence rates and erectile dysfunction for all ablative procedures were generally numerically lower than for non-ablative procedures. The safety profiles were comparable with existing treatments. Studies reporting the use of focal cryotherapy suggested that incontinence rates may be better than for whole-gland treatment. Data on AS, salvage treatment and other ablative therapies were too limited. The cost-effectiveness analysis confirmed the uncertainty from the clinical review and that there is no technology which appears superior, on the basis of current evidence, in terms of average cost-effectiveness. The probabilistic sensitivity analyses suggest that a number of ablative techniques are worthy of further research. LIMITATIONS The main limitations were the quantity and quality of the data available on cancer-related outcomes and dysfunction. CONCLUSIONS The findings indicate that there is insufficient evidence to form any clear recommendations on the use of ablative therapies in order to influence current clinical practice. Research efforts in the use of ablative therapies in the management of prostate cancer should now be concentrated on the performance of RCTs and the generation of standardised outcomes. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002461. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Joanne Gray
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Jenni Hislop
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark D F Shirley
- School of Biology, Newcastle University, Newcastle upon Tyne, UK
| | | | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sara MacLennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Robert Pickard
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kieran Rothnie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
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Srimathveeravalli G, Cornelis F, Mashni J, Takaki H, Durack JC, Solomon SB, Coleman JA. Comparison of ablation defect on MR imaging with computer simulation estimated treatment zone following irreversible electroporation of patient prostate. SPRINGERPLUS 2016; 5:219. [PMID: 27026913 PMCID: PMC4771651 DOI: 10.1186/s40064-016-1879-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/16/2016] [Indexed: 12/18/2022]
Abstract
To determine whether patient specific numerical simulations of irreversible electroporation (IRE) of the prostate correlates with the treatment effect seen on follow-up MR imaging. Computer models were created using intra-operative US images, post-treatment follow-up MR images and clinical data from six patients receiving IRE. Isoelectric contours drawn using simulation results were compared with MR imaging to estimate the energy threshold separating treated and untreated tissue. Simulation estimates of injury to the neurovascular bundle and rectum were compared with clinical follow-up and patient reported outcomes. At the electric field strength of 700 V/cm, simulation estimated electric field distribution was not different from the ablation defect seen on follow-up MR imaging (p = 0.43). Simulation predicted cross sectional area of treatment (mean 532.33 ± 142.32 mm(2)) corresponded well with the treatment zone seen on MR imaging (mean 540.16 ± 237.13 mm(2)). Simulation results did not suggest injury to the rectum or neurovascular bundle, matching clinical follow-up at 3 months. Computer simulation estimated zone of irreversible electroporation in the prostate at 700 V/cm was comparable to measurements made on follow-up MR imaging. Numerical simulation may aid treatment planning for irreversible electroporation of the prostate in patients.
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Affiliation(s)
- Govindarajan Srimathveeravalli
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Francois Cornelis
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA ; Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Joseph Mashni
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Haruyuki Takaki
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Jeremy C Durack
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Stephen B Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
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Feijoo ERC, Sivaraman A, Barret E, Sanchez-Salas R, Galiano M, Rozet F, Prapotnich D, Cathala N, Mombet A, Cathelineau X. Focal High-intensity Focused Ultrasound Targeted Hemiablation for Unilateral Prostate Cancer: A Prospective Evaluation of Oncologic and Functional Outcomes. Eur Urol 2016; 69:214-20. [DOI: 10.1016/j.eururo.2015.06.018] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
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Polascik TJ, Tay KJ, Moul JW. Keeping an Open Mind About Novel Concepts for Management of Prostate Cancer. Eur Urol 2015; 68:937-8. [DOI: 10.1016/j.eururo.2015.02.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/20/2015] [Indexed: 01/13/2023]
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A prospective clinical trial of HIFU hemiablation for clinically localized prostate cancer. Prostate Cancer Prostatic Dis 2015; 19:79-83. [PMID: 26597660 DOI: 10.1038/pcan.2015.55] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/12/2015] [Accepted: 10/11/2015] [Indexed: 01/29/2023]
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Shoji S, Nakano M, Fujikawa H, Endo K, Hashimoto A, Tomonaga T, Terachi T, Uchida T. Urethra-sparing high-intensity focused ultrasound for localized prostate cancer: Functional and oncological outcomes. Int J Urol 2015; 22:1043-9. [DOI: 10.1111/iju.12876] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Sunao Shoji
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Mayura Nakano
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Hiroshi Fujikawa
- Department of Radiology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Kazuyuki Endo
- Department of Radiology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Akio Hashimoto
- Department of Radiology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Tetsuro Tomonaga
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Toshiro Terachi
- Department of Urology; Tokai University School of Medicine; Isehara Kanagawa Japan
| | - Toyoaki Uchida
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
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Veereman G, Jonckheer P, Desomer A, Van Brabandt H, D'Hont C, Van Velthoven R, Tombal B. Systematic Review of the Efficacy and Safety of High-intensity Focussed Ultrasound for Localised Prostate Cancer. Eur Urol Focus 2015; 1:158-170. [PMID: 28723429 DOI: 10.1016/j.euf.2015.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/01/2015] [Accepted: 04/25/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT High-intensity focussed ultrasound (HIFU) has been used for 10 yr to treat localised prostate cancer (PCa). OBJECTIVE To evaluate systematically the evidence on the efficacy and side effects of HIFU in the primary treatment of localised PCa. EVIDENCE ACQUISITION We performed a critical review and appraisal of Medline (Ovid), PreMedline, Embase, and Cochrane Database of Systematic Reviews publications on HIFU up to May 2013. One systematic review and 18 primary studies, all case series, were eligible. EVIDENCE SYNTHESIS Outcomes were summarised and evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation methodology. Low-quality evidence suggests an overall survival rate after Ablatherm HIFU ranging from 80% to 89% for >5 yr. The PCa survival rate ranges from 97% to 99% for >5 yr. Effect of HIFU on quality of life remains undetermined. Erectile dysfunction was the most frequent adverse event reported from zero but up to 74% of patients. Adverse events affecting the urinary tract occurred in 0.7-31% of patients, bladder outlet obstruction in 4-51.5%, and they were more frequent in patients who had transurethral resection of the prostate the same day or within 2 d of HIFU. Outcomes vary for low- and high-risk categories. CONCLUSIONS Good quality evidence on the efficacy of HIFU treatment for localised PCa is lacking. PATIENT SUMMARY We reviewed all the data on treatment with high-intensity focussed ultrasound (HIFU) for localised prostate cancer (PCa). The quality of the evidence is very low because the information is based on a series of patients who received HIFU treatment with no comparison with active surveillance or radical treatment. Case series suggest an overall survival rate up to 89% and a PCa survival rate up to 99% after 5 yr, but these numbers vary according to the patient's risk category. Longer term and effects on quality of life are unknown.
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Affiliation(s)
| | | | - Anja Desomer
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Chris D'Hont
- Department of Urology, AZ Middelheim, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
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Shah TT, Kasivisvanathan V, Jameson C, Freeman A, Emberton M, Ahmed HU. Histological outcomes after focal high-intensity focused ultrasound and cryotherapy. World J Urol 2015; 33:955-64. [PMID: 25944676 PMCID: PMC4480821 DOI: 10.1007/s00345-015-1561-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/13/2015] [Indexed: 01/28/2023] Open
Abstract
Introduction Focal therapy has increasingly become an accepted treatment option for patients with localised prostate cancer. Most follow-up protocols use a mixture of protocol biopsies or “for cause” biopsies triggered by a rising PSA. In this paper, we discuss the histological outcomes from these biopsies and their use in guiding subsequent management and trial development. Methods We conducted a literature search and reviewed the post-treatment biopsy results from studies on focal HIFU and focal cryotherapy. We subsequently reviewed the results of three recently published consensus statements released discussing many of the issues concerning focal therapy. Results Research suggests that 1 in 5 of all post-treatment biopsies after focal therapy are positive. However, the majority of these seemed to be from the untreated portion of the gland or met criteria for clinically insignificant disease. The histological outcomes from focal therapy are promising and confirm its effectiveness in the short to medium term. Furthermore re-treatment is possible whilst maintaining a low-side-effect profile. Conclusion Debate is ongoing about the clinical significance of various levels of residual disease after focal therapy and the exact threshold at which to call failure within a patient who has had focal therapy.
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Affiliation(s)
- Taimur T Shah
- Division of Surgery and Interventional Science, Urology Research Group, UCL, Room 4.23, 4th Floor, 132 Hampstead Road, London, NW1 2PS, UK,
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What tumours should we treat with focal therapy based on risk category, grade, size and location? Curr Opin Urol 2015; 25:212-9. [PMID: 25844714 DOI: 10.1097/mou.0000000000000170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shoji S, Hashimoto A, Nakamoto M, Fukuda N, Fujikawa H, Endo K, Tomonaga T, Nakano M, Terachi T, Uchida T. Morphological analysis of the effects of intraoperative transrectal compression of the prostate during high-intensity focused ultrasound for localized prostate cancer. Int J Urol 2015; 22:563-71. [DOI: 10.1111/iju.12747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/27/2015] [Accepted: 01/28/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Sunao Shoji
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Akio Hashimoto
- Department of Radiology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Masahiko Nakamoto
- Department of Radiology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Norio Fukuda
- Department of Radiology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Hiroshi Fujikawa
- Department of Radiology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Kazuyuki Endo
- Department of Radiology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Tetsuro Tomonaga
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Mayura Nakano
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Toshiro Terachi
- Department of Urology; Tokai University School of Medicine; Isehara Kanagawa Japan
| | - Toyoaki Uchida
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
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Marshall S, Taneja S. Focal therapy for prostate cancer: The current status. Prostate Int 2015; 3:35-41. [PMID: 26157765 PMCID: PMC4494637 DOI: 10.1016/j.prnil.2015.03.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 03/16/2015] [Indexed: 12/29/2022] Open
Abstract
Purpose In an era of increasing prostate cancer incidence and earlier detection, the assessment of clinical significance of prostate cancer is critical. Minimally invasive therapies are increasingly being investigated in localized prostate cancer. Methods and results In this review, we discuss the current status of magnetic resonance imaging targeted fusion prostate biopsy and focal therapy for prostate cancer, its rationale, and techniques. Conclusion Focal therapy offers a promising outlook for prostate cancer treatment, with the goal of effectively achieving cancer control while minimizing morbidity. Long term studies are needed.
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Zhang M, Liu L, Wang J, Lu K, Shu Y, Wang R, Liu P. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:435-440. [PMID: 25715364 DOI: 10.7863/ultra.34.3.435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This retrospective study aimed to compare the efficacy and safety of combination treatment with high-intensity focused ultrasound (HIFU) and chemotherapy to those of chemotherapy alone for treatment of the abdominal lymph node metastasis from gastric cancer. METHODS A total of 185 patients with gastric cancer and abdominal lymph node metastasis were enrolled and divided into 2 groups: group A received chemotherapy alone (n = 102); group B received HIFU combined with chemotherapy (n = 83). The clinical efficacy and safety of the groups were then analyzed. RESULTS The overall response rates of groups A and B were 34.3% and 47.0%, respectively (P = .046). The pain relief rates in groups A and B were 51.6% and 75.0% (P = .039). At the data cutoff, the median survival times of groups A and B were 8.6 and 11.9 months (P < .05). The adverse reactions in the groups did not show significant differences (P > .05). Among the patients treated with HIFU and chemotherapy, those with small abdominal lymph nodes (diameter <3 cm) had a better prognosis than those with large nodes (diameter ≥3 cm). CONCLUSIONS In patients with gastric cancer and abdominal lymph node metastasis, the combination of HIFU and chemotherapy can provide clinical benefits. High-intensity focused ultrasound could effectively facilitate treatment of abdominal lymph node metastasis from gastric cancer.
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Affiliation(s)
- Meiling Zhang
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.Z., L.L., J.W., K.L., Y.S., R.W., P.L.); and Cancer Center, Nanjing Medical University, Nanjing, China (Y.S., P.L.)
| | - Lingxiang Liu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.Z., L.L., J.W., K.L., Y.S., R.W., P.L.); and Cancer Center, Nanjing Medical University, Nanjing, China (Y.S., P.L.)
| | - Jian Wang
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.Z., L.L., J.W., K.L., Y.S., R.W., P.L.); and Cancer Center, Nanjing Medical University, Nanjing, China (Y.S., P.L.)
| | - Kaihua Lu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.Z., L.L., J.W., K.L., Y.S., R.W., P.L.); and Cancer Center, Nanjing Medical University, Nanjing, China (Y.S., P.L.)
| | - Yongqian Shu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.Z., L.L., J.W., K.L., Y.S., R.W., P.L.); and Cancer Center, Nanjing Medical University, Nanjing, China (Y.S., P.L.)
| | - Rongsheng Wang
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.Z., L.L., J.W., K.L., Y.S., R.W., P.L.); and Cancer Center, Nanjing Medical University, Nanjing, China (Y.S., P.L.).
| | - Ping Liu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (M.Z., L.L., J.W., K.L., Y.S., R.W., P.L.); and Cancer Center, Nanjing Medical University, Nanjing, China (Y.S., P.L.)
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Barayan GA, Aprikian AG, Hanley J, Kassouf W, Brimo F, Bégin LR, Tanguay S. Outcome of repeated prostatic biopsy during active surveillance: implications for focal therapy. World J Urol 2014; 33:1275-80. [DOI: 10.1007/s00345-014-1433-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/23/2014] [Indexed: 11/29/2022] Open
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Marien A, Gill I, Ukimura O, Nacim B, Villers A. Target ablation—Image-guided therapy in prostate cancer11Arnaud Marien is supported by a Grant from ARC. Inderbir Gill is a paid consultant for Hansen Medical and EDAP. Osamu Ukimura is an Advisory Board Member of SonaCare Medical LLC. All others have nothing to disclose. Urol Oncol 2014; 32:912-23. [DOI: 10.1016/j.urolonc.2013.10.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/16/2013] [Accepted: 10/19/2013] [Indexed: 11/28/2022]
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Valerio M, Emberton M, Barret E, Eberli D, Eggener SE, Ehdaie B, Jichlinski P, Ward JF, Ahmed HU. Health technology assessment in evolution - focal therapy in localised prostate cancer. Expert Rev Anticancer Ther 2014; 14:1359-67. [PMID: 24965212 DOI: 10.1586/14737140.2014.932692] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Focal therapy in prostate cancer aims to treat only the part of the gland harboring clinically significant disease while preserving the rest of the tissue. This approach may substantially reduce treatment-related toxicity without compromising disease control outcomes. Short- to medium-term functional and oncological results in prospective interventional studies are promising, but comparative effectiveness research against standard of care is required to incorporate focal therapy among standard options. In this review, we discuss the actual stage of assessment and results of sources of energy commonly used to deliver focal therapy. We also provide our viewpoint on how the field will evolve in the near future.
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Affiliation(s)
- Massimo Valerio
- Division of Surgery and Interventional Science, University College London, London, UK
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Jácome-Pita F, Sánchez-Salas R, Barret E, Amaruch N, Gonzalez-Enguita C, Cathelineau X. Focal therapy in prostate cancer: the current situation. Ecancermedicalscience 2014; 8:435. [PMID: 24944577 PMCID: PMC4049329 DOI: 10.3332/ecancer.2014.435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Indexed: 11/06/2022] Open
Abstract
Prostate cancer is one of the most significant pathologies in the field of urology. The adoption of screening strategies and improvements in biopsies have resulted in an increase in early-stage tumour detection. Radical global therapies provide very good oncological results in localised prostate cancer. However, excess treatment in low- and, in some cases, intermediate-risk groups affects the quality of life of these patients. In the case of localised prostate cancer, focal therapies offer a minimally invasive option with good results with respect to established treatments. Although this is currently not a standard treatment, it represents the therapeutic approach with the greatest potential. This literature review has the following objectives: to define selection criteria for patients who are candidates for focal therapy, to assess the current situation and results of the different therapeutic options, and to define procedures in cases of recurrence and for follow-ups. We concluded that focal therapy is a viable therapeutic alternative for localised prostate cancer, specifically cryosurgery and high-intensity targeted ultrasound, which have acceptable oncologic results and a lower comorbidity compared with global treatments. Studies with a high level of scientific evidence are still needed to validate these results.
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Affiliation(s)
- Fx Jácome-Pita
- Urology Department, Fundación Jiménez Díaz, Madrid 28040, Spain
| | - R Sánchez-Salas
- Urology Department, Institut Montsouris, Paris 75014, France
| | - E Barret
- Urology Department, Institut Montsouris, Paris 75014, France
| | - N Amaruch
- Urology Department, Fundación Jiménez Díaz, Madrid 28040, Spain
| | | | - X Cathelineau
- Urology Department, Institut Montsouris, Paris 75014, France
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