Prostate news article, February 2005
| FOCAL THERAPY
IN PROSTATE CANCER: FUTURE TRENDS.
Al Barqawi and E. David Crawford, University of Colorado Health Sciences Center, Denver, Colorado, USA. British Journal of Urology, (International) 95 (3) : February 2005 Reviewed by: Mr Zach Dovey, MRCP FRCS |
These authors explain the current trends for a more "localised" treatment of prostate cancer, based on the earlier diagnosis of the disease, with the use of the PSA test, when only certain parts of the gland may be affected. The authors suggest future treatment could be directed at the cancerous foci within the gland, rather than removing the entire prostate. They use the analogy of "lumpectomy" for breast cancer rather than mastectomy.
For this to be successful, it would be important to use highly accurate biopsy techniques; saturation biopsies are the most thorough at the moment. Also promising advances in imaging using MRI via a probe in the rectum, radioisotope tracer techniques, dual imaging with CT scanners and Prostascint monoclonal antibody scanning will help to carefully localise "islands" of cancer within the otherwise normal gland. This could be combined with a real time 3-D topographical reconstruction of the prostate, which is now available.
Using these sophisticated imaging techniques, minimally invasive surgery such as Cryotherapy ( see elsewhere on the web-site for further information ) would be ideal to destroy the focal disease, by targeting an island of cancer with a "freezing" cryotherapy needle.
The advantage of focal therapy would be maintaining effective curative and survival rates without the complications of primary surgery or radiotherapy, such as incontinence, erectile dysfunction or radiation injury to the rectum. On the negative side, cancers may be missed, use of the PSA test afterwards becomes confusing and there is no final histology on which to base future therapy.
Nevertheless, therapy for prostate cancer is an ever changing field and this is one more possible treatment modality that may gain favour in the future.
We will keep you informed on the Prostate News Page.