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Thread: (J) Focal Therapies

  1. #1

    (J) Focal Therapies

    Table of Contents
    A title in all caps does not reflect any emphasis; it is simply how it appeared on the page I copied from.
    Studies in red are new additions.


    [#1] Focal Therapy in Primary Localised Prostate Cancer: The European Association of Urology Position in 2018

    [#2] Can Focal Therapy Replace Radical Therapy for Prostate Cancer? Against Focal Therapy [2018]

    [#3] Focal therapy will be the next step on prostate cancer management? | Opinion: No [2017]

    Focal therapy will be the next step on prostate cancer management? | Opinion: Yes [2017]

    [#4] Focal therapy for prostate cancer: the technical challenges [2017]

    [#5] PRIMARY FOCAL CRYOABLATION FOR LOW-, MEDIUM-, AND HIGH-RISK PROSTATE CANCER: OUTCOMES OF 180 PATIENTS IN MEDIAN OF 33 MONTHS FOLLOW UP [2018]

    ATTRACTIVENESS AND ACCESSIBILITY OF FOCAL THERAPY FOR PROSTATE CANCER: RESULTS OF AN INTERNATIONAL WEB-BASED SURVEY [2018]

    [#6] PREDICTORS OF POOR FUNCTIONAL OUTCOMES AFTER FOCAL HIGH INTENSITY FOCUSSED ULTRASOUND (HIFU) [2018]

    [#7] SALVAGE HIGH-INTENSITY FOCUSED ULTRASOUND FOR LOCALLY RECURRENT PROSTATE CANCER AFTER LOW-DOSE-RATE BRACHYTHERAPY: ONCOLOGIC AND FUNCTIONAL OUTCOMES [2018]

    [#8] DETERMINANTS OF ERECTILE DYSFUNCTION FOLLOWING FOCAL ABLATIVE THERAPY FOR LOCALISED PROSTATE CANCER [2018]

    [#9] New technologies and techniques for prostate cancer focal therapy: a review of the current literature [2018]

    [#10] Focal Therapy for Prostate Cancer: A More Vehement View of the Approach Could Translate into Real Benefits for Our Patients [2018]

    [#11] Which technology to select for primary focal treatment of prostate cancer?—European Section of Urotechnology (ESUT) position statement [2018]

    [#12] High-Intensity Focused Ultrasound (HIFU) Options for High-Risk Prostate Cancer [2018]

    [#13] The prostate cancer focal therapy [2018]

    [#14] Surveillance after prostate focal therapy [2018]

    [#15] Long-term outcomes of partial prostate treatment with magnetic resonance imaging-guided brachytherapy for patients with favorable-risk prostate cancer [2018]

    [#16] A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer [2018]

    Prostate cancer ultrasound treatment as effective as surgery or radiotherapy [2018]

    [#17] PD34-07 PSA FAILS TO PREDICT TREATMENT FAILURE IN FOCAL HIGH-INTENSITY FOCUSED ULTRASOUND THERAPY IN PROSTATE CANCER [2018]

    [#18] MISINFORMATION ON THE INTERNET REGARDING ABLATIVE THERAPIES FOR PROSTATE CANCER [2018]

    [#19] High Intensity Focused Ultrasound for Radiorecurrent Prostate Cancer: A North American Clinical Trial [2018]

    [#20] Focal Treatment for Unilateral Prostate Cancer Using High-Intensity Focal Ultrasound: A Comprehensive Study of Pooled Data [2018]

    [#21] High-Intensity Focused Ultrasound (HIFU) as salvage therapy for radio-recurrent prostate cancer: predictors of disease response [2018]

    [#22] Getting the Balance Right—The Benefits and Uncertainties of Focal Therapy for Significant Prostate Cancer [2018]

    [#24] Focal therapy for prostate cancer: concepts and future directions [2018]

    [#25] Prostate focal therapy: the rule or exception? [2018]

    [#26] Focal therapy for localized prostate cancer: is there a “middle ground” between active surveillance and definitive treatment? [2018]

    [#27] Focal therapy of prostate cancer [2018]

    [#28] Focal therapy in localised prostate cancer: Real-world urological perspective explored in a cross-sectional European survey [2018]

    [#29] Focal Ablation of Prostate Cancer [2018]

    [#30] Complications, oncological and functional outcomes of salvage treatment options following focal therapy for localized prostate cancer: a systematic review and a comprehensive narrative review [2019]

    [#31] Medium term oncological outcomes in a large cohort of men treated with either focal or hemi-ablation using HIFU for primary localized prostate cancer [2019]

    [#32] Focal therapy for prostate cancer [2019]

    [#33] Focal Laser Ablation of Prostate Cancer: Results in 120 Patients with Low- to Intermediate-Risk Disease [2019]

    [#34] Treating the primary in metastatic prostate cancer: where do we stand? [2019]

    Since June:

    [#35] Focal Therapy Should Not Be Considered for Men with Gleason Grade Group 3–5 Prostate Cancer [2019]

    Last edited by DjinTonic; 06-17-2019 at 12:22 PM.

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  6. #6
    [#1]
    Focal Therapy in Primary Localised Prostate Cancer: The European Association of Urology Position in 2018 [Full Text]

    http://www.europeanurology.com/article/S0302-2838(18 )30005-8/fulltext
    Emoticon interference: remove the space after the 18


    Article Outline

    1. Introduction
    2. Patient selection
    3. Techniques of FT
    3.1. Focal cryosurgery ablation of the prostate
    3.2. Focal HIFU
    3.3. Irreversible electroporation and radiofrequency ablation
    3.4. Focal laser ablation
    3.5. Photodynamic focal therapy
    3.6. Focal brachytherapy
    4. Statements
    4.1. Can FT treat the tumour cell clones most likely to metastasise?
    4.2. What is the evidence regarding the clinical effectiveness of FT for localised PCa?
    4.3. How does FT compare with whole-gland treatment in terms of complications?
    4.4. Is reliable follow-up of remaining prostatic tissue after FT for cancer progression possible?
    4.5. Is there increased toxicity for salvage treatment following failed FT/recurrence after FT compared with the initial whole-gland treatment?
    5. Conclusions
    References

    Abstract

    Radical treatment of localised prostate cancer is recognised to be an unnecessary intervention or overtreatment in many men. Consequently, there has been a rapid uptake in the use of focal ablative therapies. However, there are several biological and practical concerns about such approaches as they have yet to be proved as robust treatment options. In particular, the multifocal nature of prostate cancer argues against unifocal treatment, while limitations in imaging can preclude the accurate identification of the number, location, and extent of prostate cancer foci. To date, a number of ablative options have reported results on mainly low-risk disease. Most series are relatively immature, with a lack of consistent follow-up, and the morbidity of retreatment is often not considered. The authors consider focal therapy to be an investigational modality, and encourage prospective recording of outcomes and recruitment of suitable patients.
    First Forum post: https://www.cancerforums.net/threads/54174-Focal-Therapy-in-Localized-PCa-The-European-Position-in-2018
    Last edited by DjinTonic; 05-02-2018 at 05:17 AM.

  7. #7
    [#2]
    Can Focal Therapy Replace Radical Therapy for Prostate Cancer? Against Focal Therapy [2018, Full text]

    http://www.eu-focus.europeanurology.com/article/S2405-4569(18 )30012-9/fulltext
    Emoticon interference: Remove the space after the 18

    Abstract

    Take Home Message. Until prospective data demonstrate the oncologic efficacy of focal therapy for clinically significant, localized prostate cancer, it should be considered as experimental and only performed within the confines of a clinical trial.
    First Forum post: https://www.cancerforums.net/threads/54335-Can-Focal-Therapy-Replace-Radical-Therapy-for-Prostate-Cancer-Against-Focal-Therapy

  8. #8
    [#3]
    Focal therapy will be the next step on prostate cancer management? | Opinion: No
    [2017, Full Text]

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734063/

    ...
    Also, FT technique may “theoretically” preserve surrounding tissues of healthy prostate, as well as neuro-vascular and sphincter structures responsible for potency and urinary continence, respectively (7). “Preliminary” results of current studies show good acceptance, low side effects and good oncologic results.

    The bigger question of FT is related to the bad quality of scientific studies published: most include preliminary analysis, with low casuistic, short follow up and inadequate methodology (6).


    In a systematic review (SR) recently published on FT, 43 retrospective studies were included, with low level of evidence and none randomized. In that SR, it was included 6 studies involving cryotherapy, 12 HIFU, 1 photodynamic therapy, 3 photothermal therapy, 1 radiofrequency, 1 brachytherapy guided by magnetic resonance image, and 1 with several ablation techniques, with a medium follow-up of 6 years, comprising 25 studies with 2,332 treated patients (8 ). Although it may seem that the number of studies and treated patients is adequate, several FT methods were used, characterizing heterogeneous groups, with short follow up period of time.

    Most studies selected only patients with tumors with minimum volume, with PSA <10ng/mL, absence of Gleason 4 and 5, and low volume of disease demonstrated by histologic evaluation. This means that FT was offered to patients with very low risk tumors as an alternative to active surveillance (9).

    It is fundamental to detect correctly the localization of the prostate tumor in order to perform FT. Nowadays, there is no image method totally reliable for that. Previous analysis showed that transrectal biopsy guided by ultrasound (USTR) is inaccurate to identify FT candidates and correct localization of PC. Transperineal template guided biopsy is the most recommended method to localize the disease for FT treatment, but it is an invasive method (10).
    ...
    CONCLUSIONS
    Radical prostatectomy is still the standard treatment with better cure rates for localized PCa. Radiotherapy or brachytherapy are good alternatives for selected patients. Very low risk tumors must be submitted to active surveillance as first option. Available studies regarding FT present low level of evidences due to small number of patients, inadequate methodology, retrospective analysis and short period of follow up. Since there are still unsolved controversies, such as the existence of “index tumor”, the best evaluation of location of lesions, how to follow up such patients and how to detect failure, most FT treatments must be still be considered as experimental.

    Focal therapy will be the next step on prostate cancer management? | Opinion: Yes [2017, Full Text]

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734062/

    ...
    At present, there are several FT equipment's as: Focal HIFU, Focal cryotherapy, laser ablation, interstitial laser thermotherapy, photodynamic therapy, irreversible electroporation, focal brachytherapy, focal radiotherapy, nanoparticles thermotherapy, interstitial thermal microwave therapy and interstitial radiofrequency ablation.

    In relation to surgeons, new propositions of FT in prostate cancer surgery are also evolving. Recently, Villers et al. reported, for the first time, early results and complications rates of robotic partial prostatectomy, in the treatment of anterior apical tumors (15, 16) that are not suitable for the above mentioned FT modalities. Although we must have to wait for more data in this field, they confirm that FT will be one of the next steps for the treatment of primary low/intermediate risk, low volume, or recurrent localized PC.

    Several concerns regarding FT have been questioned as: How to identify precisely the target area and its safe margins? How to deliver more precisely the energy? How to follow-up patients after therapy? What would be the best PSA level after treatment (since there are normal parenchyma that continues to produce this marker)? How to detect therapeutic failures? What would be the success and of salvage treatments applied for FT recurrences? What about the costs of FT?. It is necessary to differentiate recurrences from new lesions, and recurrences from new treatments etc.

    As in almost all other aspects of prostate cancer, open questions still remain. Despite of these, new conservative treatment of this malignance is warranted and FT will be better understand with time. In this new era, for small low risk tumors, AS will continue to be the best approach; for locally advanced and high risk tumors, WGT (with or without multidisciplinary approach) will continue to be the preferred options. Between these two groups, there is a large amount of men with PC that will benefit from focal treatment of their tumors.

  9. #9
    [#4]
    Focal therapy for prostate cancer: the technical challenges
    [2017, Full Text]

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611463/

    Abstract

    Focal therapy for prostate cancer has been proposed as an alternative treatment to whole gland therapy, offering the opportunity for tumor dose escalation and/or reduced toxicity. Brachytherapy, either low-dose-rate or high-dose-rate, provides an ideal approach, offering both precision in dose delivery and opportunity for a highly conformal, non-uniform dose distribution. Whilst multiple consensus documents have published clinical guidelines for patient selection, there are insufficient data to provide clear guidelines on target volume delineation, treatment planning margins, treatment planning approaches, and many other technical issues that should be considered before implementing a focal brachytherapy program. Without consensus guidelines, there is the potential for a diversity of practices to develop, leading to challenges in interpreting outcome data from multiple centers. This article provides an overview of the technical considerations for the implementation of a clinical service, and discusses related topics that should be considered in the design of clinical trials to ensure precise and accurate methods are applied for focal brachytherapy treatments.
    ...
    Conclusions

    This article has focused on the technical challenges of introducing a focal brachytherapy program, noting that many consensus reports provide detailed discussions on the clinical aspects. Focal brachytherapy has the potential to achieve significant gains in minimizing treatment related toxicity and increase tumor control, but is not yet widely practiced. Until clear evidence exists that focal therapy is safe and clinically effective, it should only be practiced in the context of a clinical trial. We have presented an overview of some of the technical challenges in introducing a focal program, and provide suggestions for a scientific approach to applying advanced technology to develop a precise and accurate method for focal brachytherapy treatments.

  10. #10
    [#5]
    PRIMARY FOCAL CRYOABLATION FOR LOW-, MEDIUM-, AND HIGH-RISK PROSTATE CANCER: OUTCOMES OF 180 PATIENTS IN MEDIAN OF 33 MONTHS FOLLOW UP [2018, Full Text]

    http://www.jurology.com/article/S0022-5347(18 )40887-7/abstract
    Emoticon interference: remove the space after the 8

    CONCLUSIONS
    Primary focal cryoablation provides acceptable medium-term oncologic and functional outcomes. Patients with higher PSAD (especially PSAD >= 0.25 ng/mL) have increased risk for biochemical failure, cancer recurrence, and salvage treatment.

    ATTRACTIVENESS AND ACCESSIBILITY OF FOCAL THERAPY FOR PROSTATE CANCER: RESULTS OF AN INTERNATIONAL WEB-BASED SURVEY [2018, Full Text]

    http://www.jurology.com/article/S0022-5347(18 )40887-7/abstract
    Emoticon interference: remove the space after the 8

    INTRODUCTION AND OBJECTIVES
    Focal therapy (FT) of localized prostate cancer (PCa) yields promising medium-term oncological and functional outcomes. FT role in multi-focal disease and in low-risk cancer suitable for active surveillance (AS), its recurrence rates and lack of long-term data remain open issues. Guidelines limit its use to clinical trials and FT is available only in a few academic centres. The urologists′ opinion over FT has never been investigated. We assessed the current opinion and accessibility of FT in the European urological community.

    METHODS
    We created an anonymised English language questionnaire, based on 25 items (12 on demographics, 9 on FT and 4 clinical cases), compliant to the Cherries checklist. The SurveyMonkey® platform, from Nov/2016 to Oct/2017, was employed for survey distribution. The pilot validation phase enrolled 40 urologists; the EAU mailing list was then used to spread the survey. Other channels were the mailing lists of participating European national urology societies (6/15 countries) and Twitter (during 2017 EAU Congress).

    RESULTS
    We registered 484 responders from 51 countries (88.4% from Europe). Median age was 43 years (IQ 36-52); 91.3% were urologists (n=439) from academic and/or referral centres (67.8%, n=324). PCa was the main field of expertise for 63.5% (n=302). A few (4.6%, n=22) had never heard about FT. About 50% (n=217) stated FT would represent a step forward in PCa management if proven effective (5.2% abstained, n=23; 37.7% unsure, n=167); 57.0% (n=252) would suggest FT to a patient. According 78.0% (n=343), FT will become a standard option after optimization of patient selection (n=66) or after its effectiveness was proven (n=78 ), or both (n=199). FT was most commonly defined as the treatment of all significant (life-threatening) cancer foci whilst leaving untreated the rest of the gland (43.8%, n=190). FT use represented an alternative to radical prostatectomy or radiotherapy (RT) for 33.0% (n=144), to AS for 27.8% (n=121), a salvage post-RT treatment for 7.6% (n=33) and a bare subject of research for 31.7% (n=138 ). FT was accessible by 71.5% (n=316) either in their own center (n=141) or in their region (n=175).

    CONCLUSIONS
    The urological community considers FT an attractive option for PCa therapy. According to the majority of responders, it is recommendable to suitable patients and may become a standard option by optimizing patient selection and/or demonstrating effectiveness. This survey highlights the interest and the expectations of the European urological community in FT.

 

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