Date Published: May 16, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Pierre Colin, Serge Mordon, Pierre Nevoux, Mohammed Feras Marqa, Adil Ouzzane, Philippe Puech, Gregory Bozzini, Bertrand Leroux, Arnauld Villers, Nacim Betrouni.
Current challenges and innovations in prostate cancer management concern the development of focal therapies that allow the treatment of only the cancer areas sparing the rest of the gland to minimize the potential morbidity. Among these techniques, focal laser ablation (FLA) appears as a potential candidate to reach the goal of focusing energy delivery on the identified targets. The aim of this study is to perform an up-to-date review of this new therapeutic modality. Relevant literature was identified using MEDLINE database with no language restrictions (entries: focal therapy, laser interstitial thermotherapy, prostate cancer, FLA) and by cross-referencing from previously identified studies. Precision, real-time monitoring, MRI compatibility, and low cost of integrated system are principal advantages of FLA. Feasibility and safety of this technique have been reported in phase I assays. FLA might eventually prove to be a middle ground between active surveillance and radical treatment. In conclusion, FLA may have found a role in the management of prostate cancer. However, further trials are required to demonstrate the oncologic effectiveness in the long term.
Prostate cancer is the most frequent cancer among men over 50 years old in industrialized countries. With PSA screening, development of new prostate biopsies protocols, and MRI, the accuracy of detection and localization has increased. Also, today a growing number of small-volume and low-grade cancer foci are diagnosed in young healthy men. Standard treatments for prostate cancer such as surgery or radiation involve the whole gland, even if the tumor is localized. Despite their oncologic efficiency, radical treatment modalities are associated with significant morbidity (urinary and sexual dysfunction) and may be linked to useless overtreatment, which affects quality of life of patients diagnosed with very low development of potential small localized tumors.
Table 2 summarizes the different clinical publications on FLA.
Focal therapy for prostate cancer is recent and controversial in the urological community.