Tall Allen said...JNF said...
Cryo has been long connected with low success and high negative side effects. Seems to me that a study using CyberKnife and/or NanoKnife might tell us more.
I agree that using SBRT for focal therapy is promising and underexplored. I talked to two SBRT ROs about
it. They were uninterested until I mentioned that Dr. Kamrava at UCLA has a clinical trial of focal HDR brachy:A Phase II Study of Targeted Brachytherapy for Low Risk Prostate Cancer Patients
Their response was that if HDR brachy can do that, so can SBRT (SBRT was modeled on HDR brachy). They both said they will wait to see Dr. Kamrava's results.
While whole gland
ablation has had equivocal results, focal
ablation does not appear to be associated with the same rate of SEs. Ablation usually involves cold or heat, and it's difficult to limit thermal conduction and subsequent damage to nerves, sphincters, etc. unless the treatment area is very limited. Also, the cells can have a protective response to heat or cold that may limit their destruction.
The question in my mind is whether any
focal therapy has any advantage over AS. It seems to me that the same kinds of tumors (unifocal or small isolated index lesions) that are most amenable to focal therapy are also most likely to be insignificant and indolent -- perfect candidates for AS. Given the emerging long-term success rates for AS, I've begun to question the need for any focal therapy. In what cases would it be better than AS? Is there really any timing/survival advantage? Perhaps useful in the youngest men?
I've admitted to being possibly over treated and if dx was now would probably do AS. But what it's good for are those who are in the get it out of me panic club. This would do that and they would still have a functioning prostate. I still have all my valves so continence is the same as before treatment. the only SE I have is about
a 60% loss of ejaculant volume. So I can see where AS and TFT clash in a perfect world where guys can do AS for years but until we change the mindset for all those get it out of me!!!!!! guys TFT is far better than current radical treatments. BTW if TFT fails there are still the same old initial treatments AS to the now I believe tarnished 20th century gold standard of radical surgery. TFT is truly a 21st century treatment with more to come. Another very valid reason I always thought to justify AS as to see what happens in the future PCa treatments.
Below is from my hospital's TFT website. http://3dprostate.com/
Targeted Focal Therapy (TFT) is a new approach for management of early stage, organ-confined prostate cancer. It involves selective destruction of only the areas of cancer within the prostate and sparing the rest of the healthy prostatic tissue and surroundings. This selective destruction can be achieved through freezing or heating (microwaves, laser, etc.) the tumor. The rationale behind this approach is to preserve quality of life by minimizing the side effects often caused during prostate cancer surgery, which inevitable damages vital structures around the prostate such as the bladder, urinary sphincter, and nerves in the vicinity of the prostate and the rectum.
3D Mapping is the 3-dimensional, real-life reconstruction of the prostate gland based on pathology results from prostatic biopsies integrated to ultrasound and CT-scan imaging of the gland in a transperineal plane. With the use of innovative software, the rendering of a 3D image of the prostate, including the malignant lesions, allows us to identify exactly where the cancer is located; subsequently we can treat only the cancer using TFT.
Post Edited (Ziggy9) : 6/21/2013 10:10:32 AM (GMT-6)