Technical Aspects of Focal Therapy in Localized Prostate Cancer.pdf
Focal therapy is a compelling option for selected patients who have unilateral low-risk prostate cancer, providing an alternative between active surveillance and radical therapies by targeting the index lesion and preserving as much tissue as possible. Early feasibility studies have investigated cryotherapy, high-intensity focused ultrasound, brachytherapy, photodynamic therapy, laser therapy, irreversible electroporation and cyberknife methods, all of which have promising oncological outcomes. These various ablative techniques have resulted in limited rectal toxicity, had minor effects on urinary function and demonstrated a high rate of preserving erectile function. As a result, the primary end-point has now shifted and a new strategy needs to be set up for patient follow-up and for defining treatment failure.
Dr Eric Barret is a well-known urologist at Montsouris Institut in Paris, France and Dr Matthieu Durand is an urologist at Nice University hospital in France and specialist in cryotherapy. Prof. Guy Vallancien (Institut Montsouris, Paris, France) will write the Foreword. He is head of urology department at Montsouris Institut, Professor at Paris Descartes University, President of the European School of Surgery and Member of the Executive Committee of the French Urological Association. International leaders in urology contribute to the book: Frank Bladdou (Mc Gill University, Montreal, Quebec), Mark Emberton (UCL, London, UK), Vladimir Mouraviev (University of Cincinnati, Cincinnati, USA), Jean DelaRosette (AMC, Amsterdam, The Netherlands), Raphaelle Renard-Penna (Pitie-Salpetriere, Paris, France), R. Renard-Penna (Pitie-Salpetriere, Paris, France), Hedvig Hricak (MSKCC, NYC, USA), Petr Macek (University Hospital, Pragua, Czech Republic), Albert Gelet (University Hospital, Lyon, France) Jean Marc Cosset (Institut Curie, Paris, France), Hashim Ahmed (UCL, London, UK), Scott Eggener (University of Chicago Medicine, USA), Michael J Zelesky (MSKCC, NYC, USA), Duke Bahn (PIOA, Ventura, USA), Arnaud Villers (University Hospital, Lille, France), Shahrokh Shariat (Weill Cornell Medical Center, NYC, USA), John Trachtenberg (Princess Margaret Hospital, Toronto, Canada), Laurence Klotz (Sunnybrook Health Sciences Centre, Toronto, Canada).
Rational for Focal Therapy.- Concept of Index lesion.- Definition and Principles of Focal Therapy.- Eligibility for Focal Therapy: Patient Selection.- Imagingfor Focal Therapy.- Biopsies strategy.- Focal Cryotherapy.- Focal HIFU.- Focal Brachytherapy.- Focal PhotoDynamic Therapy.- Focal Laser Thermal Therapy.- Cyberknife Focal Therapy.- New Energies.- Follow-up after Focal Therapy.- Failure or Recurrence Management.- Focal Therapy Limitations.- Perspective.- Conclusion.