Focal therapy for XXXX : a critical appraisal of rationale and modalities.

@entity1 @entity263 @entity146 @entity5 @entity1486
PURPOSE: Based on contemporary epidemiological and pathological characteristics of @entity263 we explain the rationale for and concerns about focal therapy for @entity263 , review potential methods of delivery and propose study design parameters. MATERIALS AND METHODS: Articles regarding the epidemiology, diagnosis, imaging, treatment and pathology of @entity263 were reviewed with a particular emphasis on technologies applicable for focal therapy, defined as targeted ablation of a limited area of the prostate expected to contain the dominant or only focus of @entity5 . A consensus summary was constructed by a multidisciplinary international task force of @entity263 experts, forming the basis of the current review. RESULTS: In regions with a high prevalence of @entity1486 screening the over detection and subsequent overtreatment of @entity263 is common. The incidence of @entity5 in radical prostatectomy specimens is 13% to 38%. In many others there is an index lesion with secondary foci containing pathological features similar to those found incidentally at autopsy. Because biopsy strategies and imaging techniques can provide more precise @entity5 localization and characterization, there is growing interest in focal therapy targeting unifocal or biologically unifocal @entity5 . The major arguments against focal therapy are multifocality, limited accuracy of @entity5 , the unpredictable @entity146 of secondary foci and the lack of established technology for focal ablation. Emerging technologies with the potential for focal therapy include high intensity focused ultrasound, cryotherapy, radio frequency ablation and photodynamic therapy. CONCLUSIONS: Early detection of @entity263 has led to concerns that while many @entity5 now diagnosed pose too little a threat for radical therapy, many @entity1 are reluctant to accept watchful waiting or active surveillance. Several emerging technologies seem capable of focal destruction of prostate tissue with minimal morbidity. We encourage the investigation of focal therapy in select @entity1 with @entity263 in prospective clinical trials that carefully document safety, functional outcomes and @entity5 control.
