Prostate Cancer Treatment: Focal Therapy and Other Experimental Treatments

What is focal therapy?

A number of different treatments for prostate cancer are in the experimental stages.
A number of different treatments for prostate cancer are in the experimental stages.

Several new and experimental therapies for prostate cancer are under study, including treatments that use ultrasound, lasers, tissue-freezing gas, and new ways of administering radiation.

The prostate is the male gland in the pelvis that wraps around the urethra and excretes the fluid part of semen. Prostate cancer is one of the most common cancers in men.

These new methods are types of focal therapy, that is, treatment focused on the cancer cells in the prostate, rather than systemic therapy that administers medications or other treatments to the whole body with the aim of treating the prostate.

What types of focal therapy are available for prostate cancer?

Focal therapy involves ablation (a type of surgical removal) of the prostate cancer within the prostate with preservation of the surrounding healthy tissue. A number of focal therapies under investigation, but there is no basis for comparison of the efficacy of each of these therapies, given the limited data. Focal therapies being investigated include:

As many of these are considered experimental, only cryotherapy will be briefly reviewed.

What is cryotherapy (cryosurgery, cryoablation) for prostate cancer treatment?

Cryotherapy is a minimally invasive therapy that damages tissue by local freezing.

Cryotherapy is most frequently used as a salvage treatment after failure of radiation therapy. As an outpatient, hollow needles are placed into the prostate through the perineum (the space between the scrotal sac and the anus) under image guidance. A gas is passed through the needles to freeze the prostate. Warm liquid is passed through the urethra at the same time to protect it. The needles are removed after the procedure. While potentially effective for local control of cancer in the prostate gland, the side effects can be significant and include pain and the inability to urinate. Potential long-term effects include tissue damage in needle-insertion areas, impotence, and incontinence. Cryotherapy is not currently recommend as a primary treatment for management of prostate cancer.

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What are promising treatments under study for prostate cancer?

High-intensity focused ultrasound (HIFU) is an approach to therapy that is presently approved for use in Europe, and is under study in the U.S. It uses high intensity sound waves focused on the prostate gland to heat and thereby kill cancer cells. It should only be used as part of a research study (a clinical trial). The safety, side effects, and comparative effectiveness to surgery and radiation therapy must be established.

Clinical trials are research studies being conducted to evaluate new treatments for prostate cancer. These include approaches such as HIFU, as well as modifications of surgical and radiation techniques, and new drugs and immune therapy approaches.

How do you sign up for a clinical trial?

The National Comprehensive Cancer Network, a group assembled from the major comprehensive cancer centers of the U.S., considers that the best care of a cancer patient is afforded by their participation in a clinical trial. Patients with prostate cancer should always ask if there is a clinical trial option for them at any point in their therapy. Clinical trial participation assures you that your treatment has been considered by numerous cancer experts and is at least as good as a standard treatment that you may receive off of a clinical trial. In addition, the results of your treatment will be carefully analyzed in anonymous fashion, and results can be used to help others.

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Medically Reviewed on 1/9/2020
References
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American Cancer Society (ACS). <http://www.cancer.org/cancer/prostatecancer/index>.

American Urological Association. "Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline." 2017. <http://www.auanet.org/guidelines/clinically-localized-prostate-cancer-new-(aua/astro/suo-guideline-2017)>.

Byrd, E.S., et al. AJCC Cancer Staging Manual, 7th Ed. New York, NY: Springer, 2009.

The James Buchanan Brady Urological Institute. Johns Hopkins Medicine.

Lu-Yao, G.L., P.C. Albertson, D.F. Moore, et al. "Fifteen-year outcomes following conservative management among men aged 65 years or older with localized prostate cancer." Eur Urol 68.5 (2015): 805-811.

Mottet, Nicolas, et al. "Updated Guidelines for Metastatic Hormone-Sensitive Prostate Cancer: Abiraterone Acetate Combined With Castration Is Another Standard." European Urology 73 (2018): 316-321.

National Comprehensive Cancer Network

"Prostate Cancer." Memorial Sloan Kettering Cancer Center.
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