18. Evaluating Focal Therapy: Future Perspectives

  1. Hashim U Ahmed MRCS, BM, BCh, BA(Hons)1,
  2. Manit Arya FRCS, FRCS(Urol)2,
  3. Peter Carroll MD, MPH3 and
  4. Mark Emberton FRCS (Urol), FRCS, MD, MBBS, BSc1,4
  1. Hashim U. Ahmed MRCS, BM, BCh, BA(Hons)1 and
  2. Mark Emberton FRCS (Urol), FRCS, MD, MBBS, BSc1,4

Published Online: 10 NOV 2011

DOI: 10.1002/9781444346893.ch18

Focal Therapy in Prostate Cancer

Focal Therapy in Prostate Cancer

How to Cite

Ahmed, H. U. and Emberton, M. (2011) Evaluating Focal Therapy: Future Perspectives, 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.ch18

Editor Information

  1. 1

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

  2. 2

    Department of Urology, University College London, London, UK

  3. 3

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

  4. 4

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

Author Information

  1. 1

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

  2. 4

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

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:

  • randomized-clinical trials;
  • RCT;
  • pragmatic trials;
  • pragmatogram;
  • IDEAL guidelines;
  • MRC guidelines for evaluating complex interventions

Summary

Almost all other solid organ cancer therapies have as their primary aim preservation of structure and function. One way of reducing the side effects of radical therapy may be to direct treatment to only the areas of prostate cancer, what has been coined as focal therapy. To date, a number of focal therapy case series have evaluated hemiablation of unilateral disease using cryosurgery or HIFU. These have been retrospective, with small numbers, short follow-up, and poor reporting of outcomes. A number of Phase I/II prospective, ethics committee-approved trials have now reported demonstrating promising early functional and cancer control outcomes. This book has comprehensively detailed these results in the previous chapters. Where to next? How are we to ensure that informal diffusion and dissemination does not occur prior to formal evaluation within clinical comparative randomized trials? In this chapter, we propose one strategy that may deliver a randomized study in a timely and efficient fashion.