Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Aug;1(3):149-59.
doi: 10.1177/1756287209338708.

Targeted focal therapy for prostate cancer: a review of the literature

Kathryn F Sullivan  1 , E David Crawford
Affiliations

Targeted focal therapy for prostate cancer: a review of the literature

Kathryn F Sullivan et al. Ther Adv Urol. 2009 Aug.

Abstract

Improvements in prostate cancer diagnosis and treatment have resulted in a decreasing age-adjusted death rate. But improved diagnostic tools have not delivered a proportionate decrease in mortality, primarily because physicians now are diagnosing - and treating - more clinically insignificant tumors. Targeted focal therapy (TFT) uses three dimensional (3D) mapping biopsies to guide cryotherapy so that it targets lesions themselves while sparing surrounding healthy tissues, thereby avoiding side effects associated with more invasive treatments. As such, TFT can provide a bridge between active surveillance and more aggressive treatments for patients with low-risk tumors. It is appropriate for men who either do not want or are not good candidates for more aggressive therapies. Identifying patients who are appropriate candidates for TFT is challenging, but the mapping biopsy technique helps identify individuals who have localized disease and could benefit from this treatment. In recent years, improvements in cryotherapy have increased its efficacy while decreasing complications. At the present time using cryotherapy to target and destroy the cancer(s) is appealing. Other approaches to less aggressive therapies are discussed including gland hemi ablation, high intensity ultrasound (HIFU) and others. Going forward, patients will benefit further from development of better imaging technologies and completion of long-term survival studies.

Keywords: PSA screening; cryotherapy; digital rectal examination; prostate cancer; targeted focal therapy (TFT); transrectal ultrasound.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Systematic Mapping Biopsy of the Prostate–Grid placement and needle projectory into the prostate. U/S = ultrasound. Adapted, with permission, from Brazell and Whitmore. [Barzell et al. 2003].
Figure 2.
Figure 2.
The top portion is an example of a cryotherapy unit. The lower portion is an example of different cryoprobes. Picture courtesy of Endocare.
Figure 3.
Figure 3.
3D reconstruction of mapping biopsies which identify foci of prostate cancer. The recreation of the foci can be used to treat with TFT.
See this image and copyright information in PMC

References

    1. Babaian R.J., Donnelly B., Bahn D., Baust J.G., Dineen M., Ellis D., et al. (2008) Best Practice Statement on Cryosurgery for the Treatment of Localized Prostate Cancer. J Urol 180: 1993–2004 - PubMed
    1. Bahn D.K., Silverman P., Lee F., Sr,, Badalament R., Bahn E.D., Rewcastle J.C. (2006) Focal prostate cryoablation: Initial results show cancer control and potency preservation. J Endourol 20(9): 688–692 - PubMed
    1. Barzell W.E., Whitmore III W.F., Andriole G.L. (2003) How to perform transperineal saturation prostate biopsy: technique addresses diagnostic, therapeutic dilemmas that arise following TRUS biopsies. Urology Times 31: 41–41
    1. Bastacky S.I., Wonjno K.U., Walsh P.C., Carmichael M.J., Epstein J.I. (1995) Pathological features of hereditary prostate cancer. J Urol 153: 987–992 - PubMed
    1. Crawford E.D., Barqawi A. (2007) Targeted Focal Therapy: A minimally invasive Ablation Technique for Early Prostate Cancer. Oncology 21(1): 27–32 - PubMed