Point counter point for prostate cancer treatment

Presentation of the Con position for Focal Therapy

The goal is to bring about cure without causing significant side effects. Focal therapy has the potential to reshape treatment of prostate cancer; however a significant group of appropriately credentialed professionals believe that the efficiency of focal therapy has yet to be proven. These professionals believe that the multifocal nature of prostate cancer makes treatment using the focal approach inadequate.

It is clear that the majority of prostate cancers are the result of a mixture of low grade, low volume disease. However, some of these cases have larger deposits of high grade large aggressive cancer in a localized area. This is known as an index lesion. On the other hand, prostate cancer that is purely low grade and low stage does not progress and has led to the concept of active surveillance. This means patients who have tumors, with these characteristics, are being treated with “surveillance” rather than aggressive therapy such as radical prostatectomy or high density radiation therapy.

It is also clear however, in this surveillance group some patients will demonstrate evidence of progressive disease.  They are then treated differently and taken out of the surveillance group. When they are studied with the new techniques of imaging in some cases there is an identification of a grouping of more aggressive cells known as the index lesion. This lesion is most likely to be causing the PSA elevation.

Regardless, in many cases prostate cancer is multi focal. The question that needs to be answered simply is; what type of cancer are we dealing with? Low volume and low grade the kind that people can live out their normal lives, or is it high grade and aggressive cancer which unless appropriately treated can be life ending?

Knowing the answers to this question opens the opportunity for a number of well established prostate cancer treatments to be considered. These include aggressive therapy such as radical prostatectomy, or total gland therapy with techniques such as high density radiation, total gland treatment with cryoablation or with HIFU which is high intensity focused ultrasound. 

We have entered into a new era in the treatment of prostate cancer. We have a wide variety of options which include radical surgical removal, total gland therapy with either cryoablation or radiation and although not yet completely accepted by the medical community focal treatment with either cryoablation or HIFU.

A fully informed patient working with a urological oncologist, radiation oncologist and/or medical oncologist will have the opportunity to be treated with a therapy customized to their particular problem which will minimize or eliminate the risk that most of us associate with the diagnosis of prostate cancer.