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Focal treatment of prostate cancer

Focal treatment of prostate cancer

Common treatment methods for prostate cancer, such as radiation therapy and radical prostatectomy, treat the entire prostate. This can be accompanied by side effects such as impotence, incontinence and possibly damage to the bladder and bowel.1,2

At the same time, they offer only a modest improvement in survival compared with Active Surveillance, i.e. observing and monitoring without intervening3. Recently, it was found that the largest cancer focus (called the index lesion) with the highest tumor grade most strongly influences cancer progression4,5. This suggests that it may be sufficient to treat this lesion6,7.

Therefore, minimally invasive focal therapies that allow precise treatment of the index lesion are also becoming increasingly popular as alternatives to traditional treatment methods. In addition to IRE, these include focal therapies based on thermal technology, such as cryosurgery, RFA (radiofrequency ablation) or HIFU (high-intensity focused ultrasound).

Electroporation spares surrounding tissue

IRE (Irreversible Electroporation) is a new form of focal therapy that has clear advantages over other focal therapy methods:

Because IRE does not ablate tissue with heat and is tissue selective to a certain extent, it spares the surrounding tissue and organs. Because of this, IRE has the potential to become not only a standard focal therapy for prostate cancer, but also a treatment option in cases that would otherwise be untreatable or where other therapies would result in permanent damage.

Other focal treatment methods:

  • Cryotherapy
  • HIFU (high-intensity focused ultrasound)
  • Radio Frequency Ablation
  • Photodynamic therapy
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References
  1. Parkin, Donald M. (2006): The evolution of the population-based cancer registry. In: Nature reviews. Cancer 6 (8), S. 603–612. DOI: 10.1038/nrc1948.
  2. Pisani, P.; Parkin, D. M.; Ferlay, J. (1993): Estimates of the worldwide mortality from eighteen major cancers in 1985. Implications for prevention and projections of future burden. In: Int. J. Cancer 55 (6), S. 891–903. DOI: 10.1002/ijc.2910550604.
  3. Bill-Axelson, Anna; Holmberg, Lars; Garmo, Hans; Rider, Jennifer R.; Taari, Kimmo; Busch, Christer et al. (2014): Radical prostatectomy or watchful waiting in early prostate cancer. In: The New England journal of medicine 370 (10), S. 932–942. DOI: 10.1056/NEJMoa1311593.
  4. Liu, Wennuan; Laitinen, Sari; Khan, Sofia; Vihinen, Mauno; Kowalski, Jeanne; Yu, Guoqiang et al. (2009): Copy number analysis indicates monoclonal origin of lethal metastatic prostate cancer. In: Nature medicine 15 (5), S. 559–565. DOI: 10.1038/nm.1944.
  5. Mouraviev, Vladimir; Villers, Arnauld; Bostwick, David G.; Wheeler, Thomas M.; Montironi, Rodolfo; Polascik, Thomas J. (2011): Understanding the pathological features of focality, grade and tumour volume of early-stage prostate cancer as a foundation for parenchyma-sparing prostate cancer therapies. Active surveillance and focal targeted therapy. In: BJU international 108 (7), S. 1074–1085. DOI: 10.1111/j.1464-410X.2010.10039.x.
  6. Ahmed, Hashim Uddin; Arya, Manit; Freeman, Alex; Emberton, Mark (2012): Do low-grade and low-volume prostate cancers bear the hallmarks of malignancy? In: The Lancet Oncology 13 (11), e509-e517. DOI: 10.1016/S1470-2045(12)70388-1.
  7. Guillaumier, Stephanie, et al. "A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer." European urology 74.4 (2018): 422-429.