New treatments for XXXX .

@entity1 @entity323 @entity263 @entity5 @entity458 @entity1486
Interest in focal therapy for @entity263 has recently been renewed owing to downward stage migration, improved biopsy and imaging techniques, and the prevalence of either @entity5 or a dominant @entity5 with @entity5 of minimal malignant potential. Several techniques have potential for focal ablation of @entity263 . Cryotherapy has been used for some time as primary therapy for complete ablation of the prostate or local recurrence after radiotherapy. Enthusiasm for cryotherapy as the primary therapy has been tempered by the uncertainty about complete ablation of the @entity5 , the frequent persistence of measurable @entity1486 levels after the procedure, and a high rate of @entity323 . Studies have reported "focal ablation" of @entity263 with cryotherapy, targeting 1 side of the gland to eliminate a @entity5 confined to that side with less risk of @entity458 . Whether cryotherapy has sufficient power to eradicate focal @entity5 and can be targeted with sufficient accuracy to avoid damage to surrounding structures remains to be demonstrated in prospective clinical trials. High-intensity focused ultrasound (HIFU) has been used widely in Europe for complete ablation of the prostate, especially in elderly @entity1 who are unwilling or unable to undergo radical therapy. For low- or intermediate-risk @entity5 , the short- and intermediate-term oncologic results have been acceptable but need confirmation in prospective multicenter trials presently underway. Whole gland therapy with transrectal ultrasound guidance has been associated with a high risk of acute urinary symptoms, often requiring transurethral resection before or after HIFU. Adverse effects on erectile function seem likely after a therapy that depends on heat to eradicate the @entity5 , but erectile function after HIFU has not been adequately documented with @entity1 -reported questionnaires. HIFU holds promise for focal ablation of @entity263 . As with cryotherapy, focal HIFU should reduce the adverse sexual, urinary, and bowel effects of whole gland ablation. New techniques are being developed to allow HIFU treatment under real-time guidance using magnetic resonance imaging, which could improve the precision and reduce the adverse effects further. Another promising technique, currently in clinical trials, is vascular-targeted photodynamic therapy, which has been used for whole gland ablation of locally recurrent @entity5 after radiotherapy and, more recently, for focal ablation of previously untreated @entity5 . In combination with a new, systemically administered photodynamic agent, laser light is delivered through fibers introduced into the prostate under ultrasound guidance. This technique does not heat the prostate but destroys the endothelial cells and @entity5 by activating the photodynamic agent. Damage to surrounding structures appears to be limited and can be controlled by the duration and intensity of the light. We have reviewed the principles of focal therapy and these new therapeutic modalities.
