16. Determining Success of Focal Therapy: Biochemical and Biopsy Strategies

  1. Hashim U Ahmed MRCS, BM, BCh, BA(Hons)4,
  2. Manit Arya FRCS, FRCS(Urol)5,
  3. Peter Carroll MD, MPH6 and
  4. Mark Emberton FRCS (Urol), FRCS, MD, MBBS, BSc4,7
  1. Al B. Barqawi MD, FRCS1,
  2. Paul D. Maroni MD2 and
  3. E. David Crawford MD3

Published Online: 10 NOV 2011

DOI: 10.1002/9781444346893.ch16

Focal Therapy in Prostate Cancer

Focal Therapy in Prostate Cancer

How to Cite

Barqawi, A. B., Maroni, P. D. and Crawford, E. D. (2011) Determining Success of Focal Therapy: Biochemical and Biopsy Strategies, in Focal Therapy in Prostate Cancer (eds H. U. Ahmed, M. Arya, P. Carroll and M. Emberton), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444346893.ch16

Editor Information

  1. 4

    Division of Surgery and Interventional Sciences, University College London, London, UK

  2. 5

    Department of Urology, University College London, London, UK

  3. 6

    Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA

  4. 7

    NIHR UCL/UCH Comprehensive Biomedical Research Centre, London, UK

Author Information

  1. 1

    Division of Urology, University of Colorado Denver School of Medicine, Aurora, CO, USA

  2. 2

    Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA

  3. 3

    University of Colorado, Denver, Aurora, CO, USA

Publication History

  1. Published Online: 10 NOV 2011
  2. Published Print: 2 OCT 2011

ISBN Information

Print ISBN: 9781405196499

Online ISBN: 9781444346893

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Keywords:

  • biochemical outcomes;
  • ASTRO;
  • Phoenix;
  • PSA doubling time;
  • PSA kinetics;
  • follow-up strategy;
  • definition of failure;
  • salvage therapy;
  • TRUS-biopsy;
  • transperineal template biopsy;
  • mapping biopsy

Summary

Proving the value of focal therapy for prostate cancer is the critical barrier that robust research must overcome prior to the adoption of focal therapy as a standard of care. Assuming the side effects of focal therapy is substantially less than radical treatments, focal treatments must be proven to be both superior to active surveillance and equivalent to standard whole-gland therapies cancer-related outcomes in order to justify the risk and investment. Since most candidates for focal therapy are low risk, demonstrating an improvement in clinically relevant end points will be challenging due to the rarity of cancer-related events in this population. Some might consider avoidance of expensive and potentially disabling whole-gland treatments in anxious low-risk patients to be success in itself. Furthermore, if local tumor control (and by extension, control of distant disease) can be shown with minimal side effects, focal therapy has the potential to treat intermediate and high risk in select patients.