Future perspective of focal therapy for localized prostate cancer

Objective:To summarize the recent literature discussing focal therapy for localized prostate cancer.Methods:A thorough literature review was performed using PubMed to identify recent studies involving focal therapy for the treatment of localized prostate cancer.Results:In an effort to decrease the morbidity associated with prostate cancer treatment,many urologists are turning to focal therapy as an alternative treatment option.With this approach,the cancer bearing portion of the prostate is targeted while leaving the benign tissue untouched.Multiparametric magnetic resonance imaging remains the gold standard for visualization during focal therapy,but new imaging modalities such as prostate specific membrane antigen/positron emission tomography and contrast enhanced ultrasound are being investigated.Furthermore,several biomarkers,such as prostate cancer antigen 3 and prostate health index,are used in conjunction with imaging to improve risk stratification prior to focal therapy.Lastly,there are several novel technologies such as nanoparticles and transurethral devices that are under investigation for use in focal therapy.Conclusion:Focal therapy is proving to be a promising option for the treatment of localized prostate cancer.However,further study is needed to determine the true efficacy of these exciting new technologies.

New frontiers in focal therapy for prostate cancer:Prostate-specific membrane antigen positron emission tomography/magnetic resonance imaging

Imaging has a central role in the context of focal therapy(FT)for prostate cancer(PCa).Prostate-specific membrane antigen(PSMA)positron emission tomography/magnetic resonance imaging(PET/MRI)is a novel imaging modality that combines the morpho-functional information of MRI with the molecular characterization of PET.Some papers reported the potential advantages of PSMA PET/MRI in different clinical scenarios.Limited evidence on PSMA PET/MRI is available in the setting of FT.PSMA PET/MRI can be an effective imaging modality for detecting primary PCa and seems to provide accurate local staging of primary PCa.PSMA PET/MRI also shows high performance for restaging and detecting tumor recurrence.The higher soft-tissue contrast and the reduction of ionizing radiation are the main advantages reported in the literature compared to PET/computed tomography.PSMA PET/MRI could represent a turning point in the management of patients with PCa in the context of FT.Further studies are needed to confirm its applications in this specific clinical setting.

The comparison of survival between active surveillance or watchful waiting and focal therapy for low-risk prostate cancer:a real-world study from the SEER database

To reduce treatment-related side effects in low-risk prostate cancer(PCa),both focal therapy and deferred treatments,including active surveillance(AS)and watchful waiting(WW),are worth considering over radical prostatectomy(RP).Therefore,this study aimed to compare long-term survival outcomes between focal therapy and AS/WW.Data were obtained and analyzed from the Surveillance,Epidemiology,and End Results(SEER)database.Patients with low-risk PCa who received focal therapy or AS/WW from 2010 to 2016 were included.Focal therapy included cryotherapy and laser ablation.Multivariate Cox proportional hazards models were used to compare overall mortality(OM)and cancer-specific mortality(CSM)between AS/WW and focal therapy,and propensity score matching(PSM)was performed to reduce the influence of bias and unmeasured confounders.A total of 19292 patients with low-risk PCa were included in this study.In multivariate Cox proportional hazards model analysis,the risk of OM was higher in patients receiving focal therapy than those receiving AS/WW(hazard ratio[HR]=1.35,95%confidence interval[CI]:1.02–1.79,P=0.037),whereas no significant difference was found in CSM(HR=0.98,95%CI:0.23–4.11,P=0.977).After PSM,the OM and CSM of focal therapy and AS/WW showed no significant differences(HR=1.26,95%CI:0.92–1.74,P=0.149;and HR=1.26,95%CI:0.24–6.51,P=0.782,respectively).For patients with low-risk PCa,focal therapy was no match for AS/WW in decreasing OM,suggesting that AS/WW could bring more overall survival benefits.

Erectile function after WSTll vascular-targeted photodynamic therapy for low-risk prostate cancer treatment

Vascular-targeted photodynamic therapy(VTP)using padeliporfin is currently assessed as a low-risk prostate cancer(LRPCa)treatment.The aim of this study was to assess erectile function outcomes of VTP for LRPCa treatment.We prospectively included all patients treated with VTP for LRPCa.The primary endpoint was the post-treatment International Index of Erectile Function score(IIEF5 score)evolution(at 6 months,12 months,and then every year for 5 years).Secondary endpoints were the need of erectile dysfunction(ED)treatment and its efficacy.Eighty-two men were included.The median follow-up was 68(range:6-89)months.There was a 3-point significant decrease in the median IIEF5 score between baseline and at 6 months post-VTP(23[range:1-25]vs 20[range:1-25],P=0.005).There was a 1-point decrease at 1 year and 2 years post-VTP compared to baseline(22[range:2-25]and 22[range:0-25],P<0.005).There was no significant difference at 3,4,and 5 years compared to baseline.Twenty-seven(32.9%)patients received ED treatment:phosphodiesterase type-5 inhibitors(PDEI5;n=18),intracavernous injections(ICI;n=9),and intra-urethral gel(n=1).The median IIEF5 score statistically significantly increased after ED treatment(7[range:0-24]vs 21[range:1-25],P<0.001).ED treatment was efficient for 75%of the patients.There was no statistically significant difference between IIEF5 score at baseline and after ED treatment(P=0.443).Forty-six patients were totally potent before VTP and among them,13 needed ED treatment post-VTP with a success rate of 69.2%.VTP induced minimal changes in erectile function with a 3-point and a 1-point reduction in the IIEF5 score at 6 months and at 1 year,respectively.When required,ED treatment was efficient.

High-intensity focused ultrasound strategies for treating prostate cancer

Prostate cancer (PCa) is a significant health concern globally, necessitating effective treatment options. Typical treatment methods for early stage, particularly localized PCa, encompass radical procedures, such as radical prostatectomy (RP) and radiotherapy (RT), and nonradical focal therapy (FT). FT is a focused approach mainly used for treating small lesions limited to a specific zone of the prostate. Its objective is to achieve cancer control when minimizing damage to benign tissue. High-intensity focused ultrasound (HIFU) is one of the most used modalities in FT for the management of PCa. The progress in HIFU technology showcases continuous advancements, offering clinicians a variety of strategies to cater to diverse patient requirements. The advancements include the development of transrectal and transurethral HIFU machines that offer enhanced treatment distances, magnetic resonance imaging (MRI) fusion capabilities, real-time monitoring, and precise ablation. These improvements contribute to increased treatment effectiveness and better outcomes for patients. This narrative review aims to summarize the use of HIFU technology and its evolution, offering diverse options to clinicians, and explores the safety, effectiveness, and quality of different HIFU strategies, such as whole-gland ablation, hemigland ablation, and focal ablation. We conclude that nonwhole-gland HIFU offers similar cancer control with better short-term functional outcomes and fewer complications compared to whole-gland ablation. Combining HIFU with transurethral resection of the prostate (TURP) improves urinary function and reduces catheterization time. Focal ablation and hemigland ablation show promise in achieving cancer control when preserving continence and potency.