Several trends are driving progress in the awareness, effectiveness and availability of focal therapy to men with localised prostate cancer, leading to more and better treatment choices.
Key Trends
- Data on its efficacy and outcomes.
A pivotal study of 1400 men following
HIFU prostate cancer treatment over 15 years demonstrated both the efficacy of this form of focal therapy and the
quality of life benefits to men who had undergone it. This broke new ground in providing evidence for offering focal therapy to men with localised prostate cancer.
- Increased awareness of non-clinical aspects of prostate cancer treatment, e.g. sexual, urinary and mental health conditions – is leading more and more men to question radical treatment.
A dedicated group of campaigners and healthcare professionals are
actively discussing these issues through social media platforms, on- and offline support groups, and channel-based initiatives in workplaces, sports and social clubs and annual events.
- Continuing advances in diagnostics and imaging, in particular, are driving more precision and accuracy in biopsying, giving clinicians a better understanding of the location, size, and severity of cancerous lesions on the prostate. This is key to determining a patient's suitability for focal therapy and, ultimately, its likelihood of success.
- New forms of tissue ablation.
Ablation is a word you will be hearing more of as new forms emerge, clinically tested and adopted. It’s a generic or nonspecific term for destroying tissue, and in terms of prostate cancer, ablation means the reliable and precise destruction of cancerous tissue while avoiding structures important for normal sexual and urinary function. Over the years, many types of energy sources have been used to ablate prostate cancer, including heat generated by ultrasound or laser and cold generated by expansion of gas. This range of energy sources is expanding.
Most established with clinical evidence building over 15 years is HIFU prostate cancer treatment and
cryotherapy.
New approaches to focal therapy are building evidence bases:
TULSA
Trans Urethral Ultrasound Ablation (TULSA) is performed in an
MRI scanner using software that provides thermometry or real-time temperatures within the prostate and surrounding structures. This allows for more precision during the treatment. The temperatures are sent to the ablation device, so the power output from the device is continuously adjusted to achieve the desired temperature at the boundary between the prostate and the surrounding normal structures. The temperature is continuously monitored every six seconds with MRI thermometry. Its key benefit is the real-time monitoring of temperatures within the prostate, although the requirement to achieve this within an MRI scanner limits its availability.
Irreversible Electroporation
Irreversible Electroporation (IRE) provides the technology for a new form of focal therapy known as
NanoKnife. While initial studies were limited but promising, a larger clinical trial is currently being undertaken in the USA called the
PRESERVE trial. It aims to evaluate the effectiveness of NanoKnife on a wider cohort of patients.
Water Vapour
Water Vapour provides a
powerful and effective energy source for treating non-cancerous diseases of the prostate and is now being developed to treat cancerous tissue as well.
Cancer ablation via water vapour is fuelled by the energy that is generated when liquid water converts to vapour or steam.
A key difference between it and other ablative technologies used in clinical practice is the uniformity of its application. Methods using thermal energy stem from a single point that is either hot or cold, and that energy then transfers from cell to cell, progressively getting cooler, or warmer, the further from the source that it gets; this leads to heating or cooling that is uneven and can be challenging to control, according to Mike Hoey, who invented the water vapour technique. He says:
“With water vapour technology, the vapour is given under pressure and moves through the space between the cells over the course of a few seconds. The energy produced is evenly distributed throughout the area and ablates uniformly as the vapour changes back to water.”
Mike joined us recently for our OnFocus podcast – have a listen
here.
Two additional ablative approaches that are being looked at for prostate cancer are based on Microwave and laser technologies. Both of these show promise but are in need of more evidence – watch this space.
Do you have questions about when and which source of focal therapy is
suitable for localised prostate cancer? Please get in touch – we’d love to hear from you.
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