4. Selection Criteria for Prostate Cancer Focal Therapy

  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. Rajat K. Jain1,
  2. Timothy K. Ito2 and
  3. Samir S. Taneja MD2,3

Published Online: 10 NOV 2011

DOI: 10.1002/9781444346893.ch4

Focal Therapy in Prostate Cancer

Focal Therapy in Prostate Cancer

How to Cite

Jain, R. K., Ito, T. K. and Taneja, S. S. (2011) Selection Criteria for Prostate Cancer Focal Therapy, 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.ch4

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

    New York University Langone Medical Center, School of Medicine, New York, NY, USA

  2. 2

    Division of Urologic Oncology, Department of Urology, New York University Cancer Institute, New York University Langone Medical Center, New York, NY, USA

  3. 3

    Urology Section, Veterans Administration, New York Harbor Healthcare System (Manhattan campus), New York, NY, 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:

  • prostate cancer;
  • index lesion;
  • focal therapy;
  • TRUS-biopsy;
  • transperineal biopsy;
  • MRI;
  • low risk;
  • selection criteria

Summary

Selection of candidates for focal therapy is dependent upon the goal of therapy, the planned method of treatment, and the philosophy of the treating physician. Common to most treatment philosophies is the assertion that focal ablative therapies are best limited to men with low-risk disease. If focal therapy is considered a curative therapy, then larger areas of the prostate must be destroyed. In this form, the desired outcome closely mimics radical therapy. In its application as a means of disease control, most men with low-risk, a possibly intermediate-risk, disease become candidates for focal therapy. Critical in this application is the ability to identify and map the site of dominant disease. Given the state of current technologies, transperineal template biopsy is the gold standard for identifying the index lesion; however, it is appealing to think that standard transrectal ultrasound-guided systematic biopsies in combination with state-of-the-art imaging may allow accurate identification in a less invasive fashion.