Focal therapy offers a novel strategy that targets the cancer rather than the prostate in an attempt to preserve tissue and function. Focal therapy is a general term for a variety of noninvasive techniques for destroying small tumors inside the prostate while leaving the remaining gland intact and sparing most of its normal tissue. study indicated that focal salvage therapy is a potential strategy for localized recurrence after radiotherapy that may reduce the harms resulting from whole-gland salvage therapies. The focal therapy is done without negatively affecting the oncological efficacy as well. Purpose: Men with localized prostate cancer currently face a number of treat-ment options that treat the entire prostate. In a recent review of literature prior to 2012, researchers identified 2,350 cases of localized prostate cancer that had been treated with focal therapy across 30 studies (Eur Urol 2014;66[4]:732-751, PMID: 23769825). Approaches to Focal Therapy of Localized Prostate Cancer For patients to be considered as candidates for focal therapy, their prostate cancer must be present in only one lobe, typically unifocal, and contained within the prostate capsule [ 17 the aim of eradicating known cancer foci and reducing collateral damages to the structures essential for maintaining normal urinary and sexual function. For men with small, localized prostate tumors, we offer a safe and effective treatment approach called focal therapy. Google Scholar 30 Ahmed, H. U. et al. For many years there have been two main approaches to managing localized prostate cancer. Tulane Health System is the only system offering this treatment in the greater New Orleans region. The aim of ths study is to assess focal brachytherapy oncologic, functional and toxicity mid-term outcomes in men who underwent prostate cancer treatment. A variety of trial groups are experimenting with differing imaging modalities to achieve these goals for focal therapy including contrast enhanced ultrasonography for photothermal (laser) therapy 29 and MRI-guided high intensity focused ultrasound therapy 30 – 32 and laser ablation. This study suggests that 1 in 5 men diagnosed with clinically localized PCa who would otherwise have selected surgical treatment have small-volume, completely unilateral cancers that would be amenable to focal-ablation therapy targeting 1 lobe of the prostate. irreversible electroporation, focal therapy, prostate, IRE, primary treatment, #ProstateCancer, #PCSM Introduction Focal therapy (FT) is an emerging therapy for localized clinically significant prostate cancer (PCa). To our knowledge, our study is the first to assess targeting of individual known cancer areas, with a margin of normal tissue, in men with multifocal as well as unifocal prostate cancer across all cancer-risk categories. Emerging data regarding oncological and quality of life outcomes from clinical trials are encouraging. One of the long-term adverse effects of radiation for prostate cancer include rectum inflammation (proctitis) with bleeding. • Loss of energy is always accompanied by prostate cancer radiation therapy. It is not uncommon to have patients who complain of fatigue for many weeks after the treatment. Focal therapy for localized prostate cancer: the “state of the art” ... allow us to tell whether any form of focal therapy has a true progression-free survival benefit in the management of localized prostate cancer comparable to other forms of management. Men with localized prostate cancer have had these options: active surveillance for low-risk tumors (frequent blood tests to monitor prostate-specific antigen levels, which can indicate the presence of cancer, and intermittent prostate biopsies) to radical therapy with surgery or radiation for patients with intermediate or high-risk tumors. The current treatment choice for men with localized prostate cancer lies between active surveillance and radical therapy. Long-term functional outcomes after treatment for localized prostate cancer. Focal therapy is a promising method of prostate cancer treatment with the potential to bridge the gap between active surveillance and radical treatment. Certain patients with lower-risk prostate cancer confined to a specific area of the prostate may benefit from a focal therapy. Focal therapy is a treatment for prostate cancer of low to intermediate aggressiveness that is completely contained (localized) within the prostate. Prostate cancer focal therapy aims to minimize the side-effects of whole gland treatments, such as radical prostatectomy and … The landscape of prostate cancer management has been rapidly evolving, with technological advances in imaging and biopsy techniques offering novel tools for focal therapy approaches. Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: A prospective two-centre study. "Focal Therapy for Prostate Cancer: If It Sounds Too Good To Be True…" "Prostate cancer is usually a multi-focal disease, meaning it is in more than just 1 or 2 spots in your prostate. KEYWORDS: focal, salvage, high-intensity focused ultrasound, prostate cancer, external beam radiotherapy. Nanospectra Biosciences‘ AuroLase Therapy, a focal therapy for prostate cancer that uses gold-silica nanoparticles, showed a good safety profile and evidence of successfully eliminating the cancer in a pilot clinical trial.. Focal therapy is a suitable alternative for localized prostate cancer. Focal therapy has become an interesting treatment strategy for localized prostate cancer. Focal ablative therapy has been evaluated for localized radio-recurrent PCa, aiming to reduce treatment-related toxicity while achieving local oncological control. "This approach is widely accepted in … In a recent systematic review on focal salvage therapy for radio-recurrent PCa, the 5 … In this fashion, focal therapy avoids overtreatment, which is common with current whole gland therapies s… Results were published in the journal PNAS, in the study, “ Gold nanoshell-localized photothermal ablation of prostate tumors in a clinical pilot device study. N. Engl. Surgeon Jonathan Coleman is a specialist in focal therapies, a set of minimally invasive techniques for eliminating small, localized tumors in the prostate. The trial will take place at the Otto-von-Guericke-University Magdeburg, in Germany, through a collaboration between the medical center and the developing company. Focal therapy uses energy sources to generate extreme temperatures that help destroy the tumors. Mayo Clinic: TULSA-PRO Ultrasound Treatment for Men with Prostate Cancer; GreenLight Laser Therapy for PROSTATE CANCER; Prostate Cancer Insurance Coverage for Focal Laser Ablation Some men with early-stage prostate cancer have a new option for treatment—focal therapy, a targeted treatment option that destroys areas of cancer in the prostate while sparing rest of the healthy tissue. The extensive use of MRI for prostate cancer treatment has led to better disease localization. Traditional treatments for localized prostate cancer are radical prostatectomy and radiotherapy. Focal therapy is a promising option for selected patients who have localized low or intermediate-risk prostate cancer, providing a compelling alternative between active surveillance and radical therapies by targeting the index lesion and preserving as much tissue as possible. Prostate cancer is a form of cancer that develops in the prostate gland. Focal therapy refers to the removal of cancer tissue within the prostate, sparing the normal tissue and thus reducing the morbidity associated with whole-organ treatment. 45 The photosensitizer is a chemical … Prostate cancer (PCa) is the most common noncutaneous cancer in men in the United States. J. Urol. If the functional outcomes that we report are reproduced in larger studies and coupled with acceptable rates of cancer control in the medium to long term, focal therapy could offer a strategy by which the burden of treatment-related side-effects are addressed for a substantial proportion of men with localised prostate cancer. Case presentation: A patient with castration-resistant prostate cancer was found to be free of metastases on whole-body magnetic resonance imaging following external beam radiotherapy, and prostate biopsy revealed a localized recurrence in the ventral prostate. J. Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy. Focal therapy stands midway between active surveillance and radical treatments, combining minimal morbidity with cancer control. It offers an alternative to radical treatment, aiming to destroy PCa while preserving benign prostatic tissue, the bladder neck, Multiparametric magnetic resonance imaging studies combined with transperineal template prostate mapping biopsies or transrectal biopsies were used to localize disease. This is true even if your biopsies or MRI show only 1 area being involved with cancer. Google Scholar 31 "The goal of focal therapy is to treat only the area with the most aggressive tumor, while leaving the rest of the prostate and its surrounding structures alone," says Derek J. Lomas, M.D., Pharm.D., a urologist at Mayo Clinic's campus in Rochester, Minnesota. Focal boost to the intraprostatic tumor in external beam radiotherapy for patients with localized prostate cancer… Focal therapy for localized prostate cancer: is there a “middle ground” between active surveillance and definitive treatment? In conclusion, focal salvage therapy using HIFU for localized recurrence after radiotherapy may have potential as a treatment option in a select group of men. To test the principle that focal therapy using HIFU might confer fewer side effects we conducted a prospective phase I/II trial. This year, nearly 250,000 men will be diagnosed with prostate cancer. VC 2012 American Cancer Society. They should all feature prostate cancer that is only in the prostate. Hi I am new to this forum and recently diagnosed with Gleason 3+4 from MR fusion biopsy, (5% G4 in one core), PSA 6.0, confirmed slide read by JH Dr. Epstein. In focal ablation, the area of the prostate that contains the most serious cancer is targeted and destroyed, rather than treating the entire prostate gland. The current treatment choice for men with localized prostate cancer lies between active surveillance and radical therapy. Focal therapy is a general term for destroying small tumors inside the prostate, while preserving normal tissue and function. However, concerns exist regarding the multifocal nature of prostate cancer and the lack of long-term oncological data for this form of treatment. Objective To assess the feasibility, safety and precision of organ-based tracking (OBT)-fusion targeted focal microwave ablation (FMA), in patients with low to intermediate risk prostate cancer. Our study aims to assess the effectiveness of this focal therapy in treating localized prostate cancer. What is focal therapy for prostate cancer? Cancer 118, 4148–4155 (2012). Also called focal ablation, focal therapy is possible in part due to recent advances in magnetic resonance imaging (MRI) that allow clinicians to pinpoint a prostate cancer’s size and location and to assess its grade. Background: Prostate cancer focal therapy aims to minimize the side-effects of whole gland treatments, such as radical prostatectomy and radiotherapy without compromising oncological efficacy. KEYWORDS: focal, salvage, high-intensity focused ultrasound, prostate cancer, external beam radiotherapy. However, they would carry side effects including urinary incontinence, sexual dysfunction, radiation cystitis and proctitis, leading to great impact on quality of life. Ahmed HU, Cathcart P, McCartan N, et al. Patients and method Ten patients with a visible index tumor of Gleason score ≤3+4, largest diameter <20mm were included. This episode of "Oncology Peer Review On-The-Go" focuses on a review article from the May issue of the journal ONCOLOGY® titled “Primary Focal Therapy for Localized Prostate Cancer: A Review of the Literature.” Corresponding author Sudhir Isharwal, MD, an assistant professor in the Department of Urology at Oregon Health & Science University in Portland, Oregon, discussed the … Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: A pilot study. Transrectal OBT-fusion targeted FMA was performed using an 18G needle. In the below interview - Abhinav Sidana, MD, Urologic Surgeon at the University of Cincinnati Medical Center, makes a case for the adoption of focal therapy for patients with prostate cancer as an alternative to radical treatment or active surveillance. Focal ablative therapy has been evaluated for localized radio-recurrent PCa, aiming to reduce treatment-related toxicity while achieving local oncological control. Given the lack of mature, meaningful data, comparisons must be based on reviewing published studies. Most studies were retrospective with variable standards of reporting. We have two clinical trials for the focal treatment of prostate cancer. Over the last period, men were constantly encouraged to get screened for prostate cancer. In cases of older men or low-risk patients, regular medical tests are conducted to make sure the cancer isn’t … To determine the safety, quality of life (QoL) and short-term oncological outcomes of primary focal irreversible electroporation (IRE) for the treatment of localized prostate cancer (PCa), and to identify potential risk factors for oncological failure. Dr. Schaeffer: Focal therapy is one type of interventional treatment for men who have localized prostate cancer and for men who have localized prostate cancer that is contained within the particular focused area of the prostate. Objectives. Validated questionnaires were used to assess functional outcomes. Several well-established treatment options, such as Patients and method Ten patients with a visible index tumor of Gleason score ≤3+4, largest diameter <20mm were included. Thirty‐nine patients received focal salvage therapy for localized recurrence after external beam radiotherapy. Median Lobe Urethral Embolus After Focal Ablation of Gleason 7 Prostate Cancer. Focal therapy is an overall term that refers to several minimally invasive treatments that target only the parts of the prostate gland where cancer is located. This method is a direct outgrowth of targeted prostate biopsy, made possible by MRI visualization of localized prostate cancer. Men with localized prostate cancer have had these options: active surveillance for low-risk tumors (frequent blood tests to monitor prostate-specific antigen levels, which can indicate the presence of cancer, and intermittent prostate biopsies) to radical therapy with surgery or radiation for patients with intermediate or high-risk tumors. This approach is an individualized, tailored treatment that intends to better preserve quality of life, namely potency and urinary continence. In February 2019 Saint John’s Cancer Institute (formerly John Wayne Cancer Institute) at the Providence Saint John’s Health Center became the first medical center in the U.S. to acquire Focal One high intensity focused ultrasound (HIFU) for treating patients with localized prostate cancer. Transrectal OBT-fusion targeted FMA was performed using an 18G needle. Focal therapy for prostate cancer is another option to consider for Stage 1 and Stage 2 prostate cancer. Focal therapy for prostate cancer lacks long term study with large populations. All methods, except Hi I am new to this forum and recently diagnosed with Gleason 3+4 from MR fusion biopsy, (5% G4 in one core), PSA 6.0, confirmed slide read by JH Dr. Epstein. This type of therapy is ruled out in cases of localized or generalized spread. Focal therapy uses ablation, which is the use of extreme temperatures or energy to destroy tumors. The first is active surveillance or “watchful waiting.”. 185, 1246–1254 (2011). What is focal therapy for prostate cancer? It has the possibility to adapt the seeds implantation to the volume and location of the tumor. What is the best doctor and hospital for focal therapy? Objective To assess the feasibility, safety and precision of organ-based tracking (OBT)-fusion targeted focal microwave ablation (FMA), in patients with low to intermediate risk prostate cancer. In the prostate up to a third of men with localized prostate cancer have unilateral disease that may be suitable for hemiablation of 1 lobe. For men with small volume, localized cancer, we are able to treat only the cancerous portion of the prostate with an ablative device while leaving the normal, non-cancerous portion of the prostate intact. Cancer 2012;118:4148-55. In focal ablation, the area of the prostate that contains the most serious cancer is targeted and destroyed, rather than treating the entire prostate gland. Focal therapy offers a middle ground therapy for men with localized prostate cancer. The cancer is traditionally treated either with "watchful waiting" or radiation and surgery. Focal therapy uses ablation to target the index lesion, the largest tumor with the highest grade. The goal is to manage the cancer by controlling growth of the index lesion. Baco E, Gelet A, Crouzet S, et al. Articles regarding the epidemiology, diagnosis, imaging, treatment and pathology of localized prostate cancer were reviewed with a particular emphasis on technologies applicable for focal therapy, defined as targeted ablation of a limited area of the prostate expected to contain the dominant or only focus of cancer. High Intensity Focused Ultrasound for Prostate Cancer What is Focal One HIFU? The goal of the treatment is to ablate, or destroy, the tumor and a safety margin within the prostate, while leaving the remainder of the gland intact. The focal therapy to deal with prostate cancer is devised to mitigate the unnecessary side effects of the whole gland treatments. 33 Level 1 evidence shows its favorable toxicity profile and preservation of genito-urinary function. Targeted treatment of localized prostate cancer using microwave needle ablation guided by MRI and Ultrasound imaging has been performed recently and was shown to be safe and effective. Cihan H Demirel, Muammer Altok, John W Davis Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA I have a 2.1cm anterior lesion and looking at either AS or some type of focal therapy (cyro, laser, ?). Focal therapy with high-intensity focused ultrasound is effective in the medium term and rarely causes urinary or rectal side effects in patients with clinically significant localized prostate cancer, a large, multicenter study shows.. Cancer 2012;118:4148-55. Over the past decade, interest in focal therapy as a less morbid option for the treatment of localized low-risk prostate cancer has recently been renewed due to downward stage migration. High-Intensity Focused Ultrasound (HIFU) is a minimally invasive treatment for localized prostate cancer that uses high-frequency sound waves directed at the cancerous tissue through an … Kerkmeijer LGW, Groen V, Pos FJ, et al. Currently available to prostate cancer patients include: PDT depends on 3 main components: a photosensitizer, visible light, and oxygen. ... R. MP30-02 Transrectally Delivered, Outpatient Mri-Guided Laser Focal Therapy Of Prostate Cancer… Surgery, radiation therapy, and hormone therapy are the three most well-established treatments for prostate cancer. Radiation therapy is one possible treatment option for prostate cancer. Prostate cancer is, most often, a slow-growing cancer. 8, 9, 10. Focal therapy uses ablation, which is the use of extreme temperatures or energy to destroy tumors. cancerous lesions in localized prostate cancer (e .g., focal laser ablation, high -intensity focused utlrasound c, ryoabal toi n r,adoi frequency abaltoi n p, hotodynamci therapy) . Focal brachytherapy is a suitable technique for focal therapy in localized prostate cancer. For men with small, localized prostate tumors, we are investigating focal therapy as a strategy to treat carefully selected men with prostate cancer. Level 1 evidence shows its favorable toxicity profile and preservation of genito-urinary function. Focal therapy (FT) is an emerging therapy for localized clinically significant prostate cancer (PCa). Articles regarding the epidemiology, diagnosis, imaging, treatment and pathology of localized prostate cancer were reviewed with a particular emphasis on technologies applicable for focal therapy, defined as targeted ablation of a limited area of the prostate expected to contain the dominant or only focus of cancer. Focal therapy is a broad term used to describe a variety of noninvasive techniques for targeting and destroying small tumors inside the prostate while sparing the normal tissue. In 2021, Dr. Pinto, a well-respected urologist at the NIH published two papers generally supportive of focal treatments for prostate cancer in low to intermediate risk disease. In a recent systematic review on focal salvage therapy for radio-recurrent PCa, the 5 … Cancer 2012;118:4148-55. Validated questionnaires were used to assess functional outcomes. Multiparametric magnetic resonance imaging studies combined with transperineal template prostate mapping biopsies or transrectal biopsies were used to localize disease. It is the second-leading cause of cancer deaths for men in the U.S. About 1 in 9 men will be diagnosed with prostate cancer in their lifetime. In patients with localized prostate cancer, focal therapies can be used to target the small areas of cancerous cells to eradicate the cancer completely. For individuals who have primary localized prostate cancer who receive focal therapy using laser ablation, high-intensity focused ultrasound, cryoablation, radiofrequency ablation, or photodynamic therapy, the evidence includes a high-quality systematic review, studies from a registry cohort, and numerous observational studies. Focal therapy for localized prostate cancer: a phase I/II trial. It is appropriate in cases of low-risk cancer and some intermediate-risk patients. And we are still encouraging them to do so since prostate cancer is a silent killer. Benefits are preservation of genitourinary function and reduced complications, but follow-up is elaborate and is associated with uncertainty as cancer-free survival appears to be lower compared to standard radical treatments. I have a 2.1cm anterior lesion and looking at either AS or some type of focal therapy (cyro, laser, ?). What is the best doctor and hospital for focal therapy? Background. 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