DEFINING THE CANDIDATE FOR SURVEILLANCE OR TARGETED FOCAL THERAPY IN PROSTATE CANCER
Authors:
C. Wiedel; G. Pohlman; P. Arangua; E. D. Crawford
Published in:
Urol List 2013; 11(3): 6-12
Overview
The burden of prostate cancer remains high, and it is the most common cancer treated by urologists. Many men are diagnosed with low risk, clinically insignificant prostate cancer. However, no adequate clinical diagnostic criteria currently exist to accurately risk stratify patients, or identify which tumors will progress to life-threatening cancer. Further compounding this problem, current transrectal ultrasound (TRUS)-guided biopsy technique has poor sensitivity. Thus, defining which patients should undergo definitive therapy, and which should undergo active monitoring is difficult and influenced by inadequate data. Three-dimensional mapping biopsy (3DM) is an emerging technique that gives the physician a model of the prostate with precise locations of malignancy. This allows for more accurate risk stratification of patients. Additionally, it allows for the use of targeted focal therapy (TFT). This is a technology that utilizes 3DM to identify focal cancerous lesions and then subsequently treats them, sparing benign tissue and the decreasing the need for more morbid, larger procedures. Imaging techniques are currently inadequate for the identification of prostate cancer. However, advances in magnetic resonance imaging (MR) and positron emission tomography (PET) are promising and will hopefully be able to identify focal cancers non-invasively, further improving the technique of focal targeted therapy.
Key words:
prostate cancer, clinically-insignificant prostate cancer, prostate cancer antigen 3, transrectal ultrasound-guided biopsy, active monitoring, three-dimensional mapping biopsy, targeted focal therapy
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