Focal therapy for prostate cancer?

Men diagnosed with prostate cancer often face a dilemma when it comes to choosing a treatment. Radiation and surgery are effective in controlling cancer, but most patients subsequently experience sexual difficulties, urological side effects, or both. Active surveillance preserves genitourinary function, but it can cause anxiety. Regular monitoring can also prove burdensome.

Two teams of researchers suggest some middle ground, a treatment that can effectively kill cancer and preserve function. They argue in favor of testing focal therapy, which only treats the tumor and a small margin of normal tissue around it. In contrast, radical therapies target the entire prostate, often damaging surrounding structures.

Candidates for focal therapy might include patients with cancer that’s confined to the prostate and limited in scope (one or two cancerous areas). Few studies of focal therapy have been completed, and those included few patients, used varying techniques, and lacked solid data on adverse effects. But with dramatic improvements in technologies like magnetic resonance imaging, physicians can more precisely map tumors than ever before.

Given the availability of the technology needed to locate and treat cancerous lesions, the researchers conclude that the concept of focal therapy should be investigated.

SOURCES: Ahmed HU, Pendse D, Illing R, et al. Will Focal Therapy Become a Standard of Care for Men with Localized Prostate Disease? Nature Clinical Practice Oncology 2007;4:632–42. PMID: 17965641.

Eggener SE, Scardino PT, Carroll PR, et al. Focal Therapy for Localized Prostate Cancer: A Critical Appraisal of Rationale and Modalities. Journal of Urology 2007;178:2260–67. PMID: 17936815.