An Update on Focal Therapy for PCa

A Spanish study:

An Update on Focal Therapy for Prostate Cancer (2023)

"Abstract
Radical treatments and active surveillance are valid therapeutic approaches for low-risk prostate cancer. The oncologic effectiveness and morbidity of Radical Prostatectomy (RP) and radiotherapy have been broadly validated. Focal therapies pursue to reduce the morbidity observed after radical treatments, while preserving the oncologic effectiveness. This study aims to review the state-of-the-art about principles, oncologic effectiveness, morbidity, and side-effects associated with leading focal therapies. We review and summarize articles related with Cryotherapy, High-Intensity Focal Ultrasound (HIFU), Photodynamic Therapy (PDT), and Irreversible Electroporating (IRE) published in MEDLINE from 2000 to 2022. There is a wide heterogeneity in terms of the measurement of effectiveness and morbidity. Hence, comparing different energies, strategies and protocols seem to be unprecise and controversial. Cryosurgery and HIFU have reported more clinical experience than PDT and IRE. Biochemical recurrence rate after the first session varied from 4.5% to 23%, and up to 20% of patients underwent a salvage radical treatment. The reported incidence of erectile disfunction and urinary incontinence ranges from 3% to 50% and 0% to 34%, respectively. [No] randomized clinical trial comparing any focal therapy to any radical treatment has been published. We conclude that the expansion of focal therapies requires the consolidation of MRI-guided fusion biopsies in everyday clinical practice. Short-term oncologic effectiveness has been proved and supports their usefulness in low-risk patients unfit for surgical treatment. However, long-term effects and the clinical experience in intermediate and high-risk patients remains limited. Currently none of the focal therapies can be considered the Gold Standard for low-risk patients."

Hi Tudpuck. I'm still doing great 15 years later. A golf buddy of mine had TFT about 6 months ago and had a rougher recovery than I did. But I kind of attribute that to now using MRIs to locate the PCa instead of my multineedle (45 cores in my case) 3D biopsy. He also had to use a catheter longer than I did and had an emergency blockage visit to an ER. Hell I just had the catheter for 3 days post op. He had it about 3 weeks altogether. I sure have no regrets. My biggest health concerns now are my knees. Had one replaced and trying not to have the other done. That was far more a difficult recovery than the PCa.

Just a quick add, new member Oldarmyvet24 on this page made it 16 years after Cryo then PCa got him again. Never can be complacent with cancer. My wife made it 16-17 years and is on the second act. You never know anything for sure…

There are other issues with focal therapies.

All the untreated tisssue remains just as prone to forming lesions as prior to treatment, so your status has to be monitored, with no guarantee that a future progression to high-grade lesions will be caught in time.

Perhaps one third of men graded G6 on biopsy have existing higher-grade lesions that were missed. These men would have been upgraded had they chosen surgery and were not good focal-therapy candidates to begin with. RP and RT treat the whole prostate.

Djin

Post Edited (DjinTonic) : 6/4/2023 6:45:51 AM (GMT-8)