Ablation of renal tumors in a rabbit model with interstitial saline- augmented radiofrequency energy [1] (multiple letters)

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Understanding the pathological features of focality, grade and tumour volume of early-stage prostate cancer as a foundation for parenchyma-sparing prostate cancer therapies: active surveillance and focal targeted therapy

OBJECTIVE To better understand the biology and incidence of the cancer foci within the prostate through a comprehensive literature review and a review of our own data, to establish the current level of knowledge regarding the pathological foundation for active surveillance (AS) or focal therapy (FT). PATIENTS AND METHODS A systematic review of the literature was performed, searching PubMed (R) from January 1994 to July 2009. Electronic searches were limited to the English language using the keywords 'prostate cancer', 'histopathology', 'radical prostatectomy', 'pathological stage' and 'focal therapy'. The authors' own data were also analysed and are presented. RESULTS Recent data have shown a significant pathological stage migration towards earlier disease comprising unilateral pT2a/b prostate cancer (PCa). The cancer volume of the clinically significant tumour (index lesion) has been proposed as a driving force of PCa progression and therefore should be identified and treated at an early stage. In general, most satellite lesions do not appear to be life-threatening. Other pathological features, such as Gleason score, extraprostatic extension and the spatial distribution of PCa within the prostate, remain important selective criteria for AS or FT. CONCLUSION The present study reviews the current knowledge of cancer focality, aggression and tumour volume. Further research is needed to better understand the biologic behaviour of each of the tumour foci within a cancerous prostate, and to employ this information to selected patients for no therapy (AS), parenchyma-preserving approaches (FT) or whole gland radical therapy

Contrast-enhanced ultrasonography

Ultrasound is the cornerstone for prostatic imaging and covers diagnostics, therapy monitoring, and follow-up. In the aspect of focal therapy, accurate prostate cancer localization is mandatory. Contrast-enhanced ultrasound (CEUS) is a promising imaging technique which has shown to greatly increase the chances to find prostate cancer in biopsies. At the moment, CEUS is only performed in expert centers because of difficult interpretation and steep learning curves. CEUS quantification techniques can make reliable and objective interpretation, with a high sensitivity, possible outside of expert centers. Focal therapy and active surveillance are increasingly used, but require to be supported by proper imaging techniques. CEUS seems a promising technique for real-time monitoring and follow-up of focal therapy treatment. In the near future, the use of targeted contrast agents will be a major breakthrough in the combat against prostate cancer. They show promising results regarding better visualization and longer lasting contrast enhancement of prostate cancer in in-vitro as well as in in-vivo animal experiments

New and Established Technology in Focal Ablation of the Prostate: A Systematic Review.

Focal therapy of prostate cancer has been proposed as an alternative to whole-gland treatments. To summarize the evidence regarding sources of energy employed in focal therapy. Embase and Medline (PubMed) were searched from 1996 to October 31, 2015 following the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Ongoing trials were selected from electronic registries. The stage of assessment of each source of energy was determined using the Idea, Development, Exploration, Assessment, Long-term study recommendations. Thirty-seven articles reporting on 3230 patients undergoing focal therapy were selected. Thirteen reported on high-intensity focused ultrasound, 11 on cryotherapy, three on photodynamic therapy, four on laser interstitial thermotherapy, two on brachytherapy, three on irreversible electroporation, and one on radiofrequency. High-intensity focused ultrasound, cryotherapy, photodynamic therapy, and brachytherapy have been assessed in up to Stage 2b studies. Laser interstitial thermotherapy and irreversible electroporation have been evaluated in up to Stage 2a studies. Radiofrequency has been evaluated in one Stage 1 study. Median follow-up varied between 4 mo and 61 mo, and the median rate of serious adverse events ranged between 0% and 10.6%. Pad-free leak-free continence and potency were obtained in 83.3-100% and 81.5-100%, respectively. In series with intention to treat, the median rate of significant and insignificant disease at control biopsy varied between 0% and 13.4% and 5.1% and 45.9%, respectively. The main limitations were the length of follow-up, the absence of a comparator arm, and study heterogeneity. Focal therapy has been evaluated using seven sources of energy in single-arm retrospective and prospective development studies up to Stage 2b. Focal therapy seems to have a minor impact on quality of life and genito-urinary function. Oncological effectiveness is yet to be defined against standard of care. Seven sources of energy have been employed to selectively ablate discrete areas of prostate cancer. There is high evidence that focal therapy is safe and has low detrimental impact on continence and potency. The oncological outcome has yet to be evaluated against standard of care

Contrast-enhanced ultrasonography

Ultrasound is the cornerstone for prostatic imaging and covers diagnostics, therapy monitoring, and follow-up. In the aspect of focal therapy, accurate prostate cancer localization is mandatory. Contrast-enhanced ultrasound (CEUS) is a promising imaging technique which has shown to greatly increase the chances to find prostate cancer in biopsies. At the moment, CEUS is only performed in expert centers because of difficult interpretation and steep learning curves. CEUS quantification techniques can make reliable and objective interpretation, with a high sensitivity, possible outside of expert centers. Focal therapy and active surveillance are increasingly used, but require to be supported by proper imaging techniques. CEUS seems a promising technique for real-time monitoring and follow-up of focal therapy treatment. In the near future, the use of targeted contrast agents will be a major breakthrough in the combat against prostate cancer. They show promising results regarding better visualization and longer lasting contrast enhancement of prostate cancer in in-vitro as well as in in-vivo animal experiments

The Role of Focal Therapy in the Management of Localised Prostate Cancer: A Systematic Review.

CONTEXT: The incidence of localised prostate cancer is increasing worldwide. In light of recent evidence, current, radical, whole-gland treatments for organ-confined disease have being questioned with respect to their side effects, cancer control, and cost. Focal therapy may be an effective alternative strategy. OBJECTIVE: To systematically review the existing literature on baseline characteristics of the target population; preoperative evaluation to localise disease; and perioperative, functional, and disease control outcomes following focal therapy. EVIDENCE ACQUISITION: Medline (through PubMed), Embase, Web of Science, and Cochrane Review databases were searched from inception to 31 October 2012. In addition, registered but not yet published trials were retrieved. Studies evaluating tissue-preserving therapies in men with biopsy-proven prostate cancer in the primary or salvage setting were included. EVIDENCE SYNTHESIS: A total of 2350 cases were treated to date across 30 studies. Most studies were retrospective with variable standards of reporting, although there was an increasing number of prospective registered trials. Focal therapy was mainly delivered to men with low and intermediate disease, although some high-risk cases were treated that had known, unilateral, significant cancer. In most of the cases, biopsy findings were correlated to specific preoperative imaging, such as multiparametric magnetic resonance imaging or Doppler ultrasound to determine eligibility. Follow-up varied between 0 and 11.1 yr. In treatment-naïve prostates, pad-free continence ranged from 95% to 100%, erectile function ranged from 54% to 100%, and absence of clinically significant cancer ranged from 83% to 100%. In focal salvage cases for radiotherapy failure, the same outcomes were achieved in 87.2-100%, 29-40%, and 92% of cases, respectively. Biochemical disease-free survival was reported using a number of definitions that were not validated in the focal-therapy setting. CONCLUSIONS: Our systematic review highlights that, when focal therapy is delivered with intention to treat, the perioperative, functional, and disease control outcomes are encouraging within a short- to medium-term follow-up. Focal therapy is a strategy by which the overtreatment burden of the current prostate cancer pathway could be reduced, but robust comparative effectiveness studies are now required