John W. Davis, MD, FACS, presented “Prostate Cancer Focal Therapy: Is it the Right Time for your Practice?” during the 23rd Annual Innovations in Urologic Practice on September 14, 2018 in Santa Fe, New Mexico.
How to cite: Davis, John W. “Prostate Cancer Focal Therapy: Is it the Right Time for your Practice?” September 14, 2018. Accessed Aug 2021. https://grandroundsinurology.com/prostate-cancer-focal-therapy-is-it-the-right-time-for-your-practice/
Prostate Cancer Focal Therapy: Is it the Right Time for your Practice? – Summary:
John W. Davis, MD, discusses the benefits and limitations of focal therapy for prostate cancer. He describes ways in which focal therapy can be a middle ground between active surveillance and standard therapies, as well as identifying appropriate candidates for this approach.
This is a partner presentation coupled with Jeffrey A. Jones’s “The Pros of Focal Therapy for Prostate Cancer.”
Compared to previous years, urologists better understand focal therapy for treating prostate cancer in 2018. Patients may or may not encounter the option via internet searches. The AUA does not recommend focal therapy outside of a research protocol due to lack of comparative evidence. One can argue focal therapy induces improved quality of life compared to other intervention methods. There may be merit to the notion of focal therapy being an “adjuvant” therapy to active surveillance. In other words, focal therapy could be a middle ground between active surveillance and standard treatments.
However, imaging precision remains the major rate limiting step, as MRI is mostly an estimate of tumor location and grade. Focal therapy remains precisely defined in terms of relative amount of tissue treated and/or ideal energy source. There is a lack of comparative literature regarding this approach, as well as a lack of robust data on the outcomes of cases requiring salvage therapy.
Finally, patients who benefit are almost exclusively favorable volume Gleason 3+4. Patients with less aggressive disease are better candidates for active surveillance. Conversely, it is appropriate for patients with more aggressive disease to continue with standard therapies. Patients should be aware that post-focal therapy will still require imaging, repeat biopsies, PSA metrics, and they may have reduced quality of life with salvage therapies compared with primary standard outcomes.
About Innovations in Urologic Practice
Innovations in Urologic Practice (IUP) is an annual CME-accredited conference devoted to updating urologists on the rapidly changing healthcare environment. Topics focus on innovative diagnostic and treatment strategies, controversies, new and currently developing technologies, and challenges in today’s urologic practice. Dr. Davis presented this lecture during the 23rd IUP in 2018. Please visit this page in order to learn more about future IUP meetings.