If I seem skeptical about
focal therapy as a primary treatment, here's why. These are the results of a small multi-institutional pilot trial of photodynamic therapy (PDT or VTP) used for hemi-ablation in low-risk men with pre-treatment biopsies indicating cancer on only one side. Of the 21 evaluable patients, post-treatment biopsies found:
• Residual cancer in 15/21 (71%) of treated men
----in the
treated lobe in 11 men (52%)
----in the untreated untreated lobe in 4 (24%)
----in both lobes in 1 (5%)
• Even in those treated with more optical fiber, 27% had residual cancer in the treated lobe
• 6 (out of 15?) men undergoing retreatment had no residual cancer
• Minimal effects on urinary and sexual function
Since all of these men were good candidates for active surveillance (which has no effect on urinary or sexual function), they were put through an invasive procedure, and they are
still on active surveillance. I am hopeful that for the 12/21 in whom no residual cancer was detected on f/u biopsy (6 at the first biopsy, 6 after the second treatment) that future biopsies will continue to find no evidence of cancer. But they will need to have those biopsies continually to monitor this.
Here's the abstract of the study:
Final Results of a Phase I/II Multicenter Trial of WST11 (TOOKAD® Soluble) Vascular-Targeted Photodynamic Therapy (VTP) for Hemiablation of the Prostate in Men with Unilateral Low Risk Prostate Cancer Conducted in the United StatesStudy details are here:
/www.clinicaltrials.gov/ct2/show/NCT00946881