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Should Focal Therapy Be Used in Localized Prostate Cancer?

The use of focal therapy in localized prostate cancer using HIFU (High-intensity focused ultrasound) was conducted in Europe from 625 men who received treatment at different centers with a median follow-up of 56 months.

The mean are reporting a high overall survival, a high (failure-free) survival, and a high metastasis-free survival. The study’s strengths are that it’s multicentered, prospective, and involves reasonable follow-up. The researchers have pointed out that based on the findings, focal HIFU is effective in managing men who’ve localized prostate cancer.

However, Dr. Gerald Chodak from Medscape raises a number of questions regarding these findings:

  • Unique characteristics: About 28 percent of men had low risk disease while 55 percent had Gleason 3 + 4 disease, making them possible candidates of surveillance with a reduced recurrence risk. The fact that most men had those characteristics doesn’t make it a good proof of how effective this approach is.
  • Follow-up period: The research required men to have 6 or more months of follow-up, and while the median is 56 months, it appears a greater percentage of men received treatment in under 2 years, which is a short follow-up period to warrant the effectiveness of the treatment.
  • Biopsy results: 25 percent of the men with biopsy had recurrent disease and qualified to be retreated. However, it’s a concern that most men didn’t have their cancer cured effectively. At five years, the freedom not to have a repeat HIFU treatment was 69 percent for men with high-risk disease, 79 percent for men with intermediate risk, and 78 percent for those with low risk. These findings don’t give much strength for the approach’s value.

A position paper in European Urology contents that focal therapy should be treated as an experimental treatment as there isn’t adequate data to show its effectiveness in eradicating or controlling the disease.