Abstract
In 2019, the American Cancer Society (ACS) estimates that 174,650 new cases of prostate
cancer will be diagnosed and 31,620 will die due to the prostate cancer in the United
States. Prostate cancer is often managed with aggressive curative intent standard
therapies including radiotherapy or surgery. Regardless of how expertly done, these
standard therapies often bring significant risk and morbidity to the patient's quality
of life with potential impact on sexual, urinary, and bowel functions. Additionally,
improved screening programs, using prostatic-specific antigen and transrectal ultrasound-guided
systematic biopsy, have identified increasing numbers of low-risk, low-grade “localized”
prostate cancer. The potential, localized, and indolent nature of many prostate cancers
presents a difficult decision of when to intervene, especially within the context
of the possible comorbidities of aggressive standard treatments. Active surveillance
has been increasingly instituted to balance cancer control versus treatment side effects;
however, many patients are not comfortable with this option. Although active debate
continues on the suitability of either focal or regional therapy for the low- or intermediate-risk
prostate cancer patients, no large consensus has been achieved on the adequate management
approach. Some of the largest unresolved issues are prostate cancer multifocality,
limitations of current biopsy strategies, suboptimal staging by accepted imaging modalities,
less than robust prediction models for indolent prostate cancers, and safety and efficiency
of the established curative therapies following focal therapy for prostate cancer.
In spite of these restrictions, focal therapy continues to confront the current paradigm
of therapy for low- and even intermediate-risk disease. It has been proposed that
early detection and proper characterization may play a role in preventing the development
of metastatic disease. There is level-1 evidence supporting detection and subsequent
aggressive treatment of intermediate- and high-risk prostate cancer. Therefore, accurate
assessment of cancer risk (i.e., grade and stage) using imaging and targeted biopsy
is critical. Advances in prostate imaging with MRI and PET are changing the workup
for these patients, and advances in MR-guided biopsy and therapy are propelling prostate
treatment solutions forward faster than ever.
Keywords
prostate cancer - MRI - prostate ablation - focal therapy for prostate
