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Focal therapy for prostate cancer

Melvy Sarah Mathew, Aytekin Oto
With the advent of focal therapy as a recognized treatment option for men with prostate cancer, there are a host of emerging interventions that take advantage of MRI for image guidance. Focal therapy affords a middleground option for patients with low- to intermediate-grade prostate cancer by providing a means of keeping their cancer at bay while avoiding the negative consequences of radical therapies. However, the practice of focal treatment is far from straightforward, with some believing focal treatment errs on the side of overtreatment among patients with low-grade cancer; others worry it is undertreatment in potentially significant multifocal disease...
October 25, 2016: Future Oncology
Xavier Cathelineau, Rafael Sanchez-Salas
Focal therapy (FT) represents a potential shift in clinical practice by featuring a tissue-sparing approach for prostate cancer (PCa) treatment. It stands midway between active surveillance (AS) and more aggressive options like radical prostatectomy (RP) or radiotherapy. The field has enormously evolved in the last few years but there are still pending questions to answer in the future. The manuscript overlooks FT in terms of indications, available energies, situation of tumor microenvironment, follow-up, re-interventions, and the future of this approach for PCa...
December 2016: Current Urology Reports
Romuald Zdrojowy, Janusz Dembowski, Bartosz Małkiewicz, Krzysztof Tupikowski, Wojciech Krajewski
INTRODUCTION: Prostate cancer is the most frequent cancer among males in Europe and a leading cause of cancer deaths, with similar proportion in other developed countries. For more than twenty years, external-beam radiation therapy, alongside with radical prostatectomy, has been used as a primary radical therapeutic approach for localized prostate cancer. Yet, EBRT failures relate to 22-69% following curative radiotherapy (± androgen deprivation therapy). Additionally, a proportion of these men will have a biopsy-proven local recurrence...
2016: Central European Journal of Urology
Nelson N Stone, Vladimir Mouraviev, David Schechter, Josh Goetz, M Scott Lucia, E Erin Smith, E David Crawford
OBJECTIVE: The biopsy needles currently used were designed for a transrectal biopsy and are known to experience significant deflection from the point of entry into the gland to the needle tip. METHODS: Five designs were selected for testing: 18-gauge Bard, 15-gauge lancet tip needle with 12° vet-point cannula, and trocar tip needle with 12°, 15°, and 20° vet-point cannulas. The 15-gauge needle was designed to take a variable specimen sample between 20 and 60 mm, whereas the Bard needle specimen bed was fixed at 20 mm...
October 5, 2016: Technology in Cancer Research & Treatment
Hossein Jadvar
Imaging of the Warburg effect, which is the principal but not the sole cause for enhanced glucose metabolism in tumors, with PET and (18)F-FDG has become the mainstay for the imaging evaluation of several cancers. Despite the seemingly prevalent notion that (18)F-FDG PET may not be useful in prostate cancer, relatively limited evidence suggests that this imaging modality can be useful for the evaluation of the extent of metastatic disease and the assessment of the therapy response and prognosis in men with castration-resistant prostate cancer...
October 2016: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
Liana B Guedes, Jeffrey J Tosoian, Jessica Hicks, Ashley E Ross, Tamara L Lotan
PURPOSE: Men with intermediate risk prostate cancer have widely variable outcomes, with some suggesting that active surveillance or less invasive therapies (brachytherapy or focal therapy) may be appropriate for some men with Gleason Score 3+4=7 disease. Molecular markers may help further distinguish prostate cancers with aggressive behavior. Here, we tested whether loss of the PTEN tumor suppressor in 3+4=7 tumor biopsies is associated with adverse pathology at prostatectomy. MATERIALS AND METHODS: We queried prostate needle biopsies from 2000-2014 with a maximum Gleason score of 3+4=7 followed by prostatectomy...
September 27, 2016: Journal of Urology
A Baydoun, B Traughber, N Morris, M McGraw, T K Podder, R F Muzic, S S Lo, L Ponsky, M Machtay, R J Ellis
No abstract text is available yet for this article.
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
J V Hegde, J Wang, D Margolis, J Huang, M Kamrava
No abstract text is available yet for this article.
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Marlon Perera, Nishanth Krishnananthan, Uri Lindner, Nathan Lawrentschuk
Globally, the increased uptake of serum PSA level screening led to an increase in the number of diagnoses of low-risk and intermediate-risk prostate cancer. Traditionally, these patients have been considered for either active surveillance programmes or radical whole-gland therapies, such as prostatectomy or radiotherapy. Focal therapy is an emerging treatment option that involves the focal ablation of prostate cancer with preservation of surrounding healthy tissue. This approach might result in reduced morbidity when compared with whole-gland therapies...
September 27, 2016: Nature Reviews. Urology
Louise Dickinson, Hashim U Ahmed, Richard G Hindley, Neil McCartan, Alex Freeman, Clare Allen, Mark Emberton, Alex P Kirkham
INTRODUCTION: Focal therapy for localized prostate cancer has the potential for oncological control without the side effects of radical therapies. However, there is currently no validated method for monitoring treatment success. We assessed the diagnostic performance of prostate-specific antigen (PSA) parameters and MRI compared to histological outcomes following focal therapy. PATIENTS AND METHODS: Patients from 3 Ethics Review Board approved prospective studies of focal high intensity-focused ultrasound (HIFU) (Sonablate 500) for localized prostate cancer (T1c-T3a, Gleason grade≤4+3, and PSA≤20)...
September 20, 2016: Urologic Oncology
Arnauld Villers, Philippe Puech, Vincent Flamand, Georges-Pascal Haber, Mihir M Desai, Sebastien Crouzet, Xavier Leroy, Sameer Chopra, Laurent Lemaitre, Adil Ouzzane, Inderbir S Gill
BACKGROUND: Focal ablative therapy may be a suboptimal option for anterior prostate cancers (APCs) reaching the prostate apex due to concerns for thermal injury to the external sphincter. OBJECTIVE: To explore the technical feasibility of anterior partial prostatectomy (APP) for isolated APCs detected by magnetic resonance imaging (MRI), and to report short-term oncologic and functional outcomes. DESIGN, SETTING, AND PARTICIPANTS: Following institutional review board approval, over an 8-yr period (2008-2015) 17 consenting patients were enrolled in a prospective single-arm single-center Innovation, Development, Exploration, Assessment, Long-term (IDEAL) phase 2a study...
September 6, 2016: European Urology
Massimo Valerio, Yannick Cerantola, Scott E Eggener, Herbert Lepor, Thomas J Polascik, Arnauld Villers, Mark Emberton
CONTEXT: Focal therapy of prostate cancer has been proposed as an alternative to whole-gland treatments. OBJECTIVE: To summarize the evidence regarding sources of energy employed in focal therapy. EVIDENCE ACQUISITION: Embase and Medline (PubMed) were searched from 1996 to October 31, 2015 following the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Ongoing trials were selected from electronic registries. The stage of assessment of each source of energy was determined using the Idea, Development, Exploration, Assessment, Long-term study recommendations...
August 29, 2016: European Urology
Sherif G Nour
Prostate cancer is the most common cancer (other than skin cancer) in American men, with one in seven men being diagnosed with this disease during his lifetime. The estimated number of new prostate cancer cases in 2016 is 180,890. For the first time, imaging has become the center of the search for contained, intraglandular, small-volume, and unifocal disease, and an increasing number of academic institutions as well as private practices are implementing programs for prostate multiplanar magnetic resonance imaging (MRI) as parts of their routine offerings...
September 2016: Seminars in Interventional Radiology
David A Woodrum, Krzysztof R Gorny, Bernadette Greenwood, Lance A Mynderse
Prostate cancer is the most commonly diagnosed noncutaneous cancer and second-leading cause of death in men. Many patients with clinically organ-confined prostate cancer undergo definitive, curative treatment of the whole gland with either radical prostatectomy or radiation therapy. However, many men are reluctant to take the definitive step due to potential morbidity associated with either therapy. A growing interest in active surveillance or focal therapy has emerged as realistic alternatives for many patients...
September 2016: Seminars in Interventional Radiology
Pritesh Patel, Aytekin Oto
This article systematically reviews the rationale for magnetic resonance imaging in prostate cancer, in detection and following various treatment methods. A basic discussion of the identification of prostate cancer is imperative to understand postintervention imaging. Each available therapy, including surgery, radiation, hormone therapy, and focal therapies will be discussed along with associated imaging findings, providing the reader with a better understanding of current interventions in prostate cancer and imaging...
September 2016: Seminars in Interventional Radiology
Nicolas Mottet, Joaquim Bellmunt, Michel Bolla, Erik Briers, Marcus G Cumberbatch, Maria De Santis, Nicola Fossati, Tobias Gross, Ann M Henry, Steven Joniau, Thomas B Lam, Malcolm D Mason, Vsevolod B Matveev, Paul C Moldovan, Roderick C N van den Bergh, Thomas Van den Broeck, Henk G van der Poel, Theo H van der Kwast, Olivier Rouvière, Ivo G Schoots, Thomas Wiegel, Philip Cornford
OBJECTIVE: To present a summary of the 2016 version of the European Association of Urology (EAU) - European Society for Radiotherapy & Oncology (ESTRO) - International Society of Geriatric Oncology (SIOG) Guidelines on screening, diagnosis, and local treatment with curative intent of clinically localised prostate cancer (PCa). EVIDENCE ACQUISITION: The working panel performed a literature review of the new data (2013-2015). The guidelines were updated and the levels of evidence and/or grades of recommendation were added based on a systematic review of the evidence...
August 25, 2016: European Urology
L Hoquetis, B Malavaud, X Game, J B Beauval, D Portalez, M Soulie, P Rischmann
OBJECTIVE: To evaluate the value of MRI for surveillance of primary hemi-HIFU therapy for localized PCa in a single-center. PATIENTS AND METHODS: Patients with localized prostate cancer were treated with hemi-HIFU from October 2009 to March 2014. All patients performed MRI before focal therapy, the reader was blinded to the treatment. Oncological failure was defined as positive biopsy or biochemical recurrence (Phoenix). RESULTS: Twenty-five patients were treated with hemi-HIFU in one center...
September 2016: Progrès en Urologie
J I Perez-Reggeti, R Sanchez-Salas, A Sivaraman, E Linares Espinos, A E de Gracia-Nieto, E Barret, M Galiano, F Rozet, A Fregeville, R Renard-Penna, N Cathala, A Mombet, D Prapotnich, X Cathelineau
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...
August 16, 2016: Actas Urologicas Españolas
Y Ahallal, R Sanchez-Salas, A Sivaraman, E Barret, F P Secin, P Validire, F Rozet, M Galiano, X Cathelineau
OBJECTIVES: To evaluate the role of Transperineal Template guided Mapping Biopsy (TTMB) in determining the management strategy in patients with low risk prostate cancer (PCa). METHODS: We retroscpectively evaluated 169 patients who underwent TTMB at our institution from February 2008 to June 2011. Ninety eight of them harbored indolent PCa defined as: Prostate Specific Antigen<10ng/ml, Gleason score 6 or less, clinical stage T2a or less, unilateral disease and a maximum of one third positive cores at first biopsy and<50% of the core involved...
August 12, 2016: Actas Urologicas Españolas
Constantinos Zamboglou, Hans-Christian Rischke, Philipp Tobias Meyer, Sven Knobe, Natalja Volgeova-Neher, Michael Kollefrath, Cordula Annette Jilg, Anca Ligia Grosu, Dimos Baltas, Malte Kroenig
PURPOSE: We present a novel method for treatment of locally recurrent prostate cancer (PCa) following radiation therapy: focal, multimodal image guided high-dose-rate (HDR) brachytherapy. MATERIAL AND METHODS: We treated two patients with recurrent PCa after primary (#1) or adjuvant (#2) external beam radiation therapy. Multiparametric magnetic resonance imaging (mpMRI), choline, positron emission tomography combined with computed tomography (PET/CT), or prostate-specific membrane antigen (PSMA)-PET combined with CT identified a single intraprostatic lesion...
June 2016: Journal of Contemporary Brachytherapy
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