One of the oldest and most respected urologic professional associations is the Société Internationale d’Urologie (SIU), headquartered in Montreal. It was founded in 1907 during a period when national and local urologic societies were getting off the ground. As part of their membership, urologists are subscribed to the World Journal of Urology. According to the journal’s website, this publication carries peer-reviewed articles that “reflect the developments in all fields of urology on an internationally advanced level.” Considering the ground urology has gained in the 108 years since the SIU was established, the journal has set itself a lofty goal. To paraphrase the old E.F. Hutton TV ad[i], when the World Journal talks, urologists listen.
The July 2015 journal issue published an article titled “The Role of Active Surveillance and Focal Therapy in Low- and Intermediate-Risk Prostate Cancers” by a panel of international urologic experts.[ii] They note that roughly 50% of men who are biopsied based on PSA screening are diagnosed with low-risk prostate cancer (PCa). These men have often been overtreated with radical surgery or whole-gland radiation, so interest in active surveillance (conservative management) and focal therapy as a way to avoid damaging side effects has increased.
After three extended meetings to interpret available data, the panel agreed on three principles:
- Initial active surveillance is appropriate for most men with low volume Gleason 6 disease.
- For men with a larger unifocal Gleason 6 or 3 + 4 tumor, focal therapy “appears to be a suitable option” even though it is still considered investigational.
- For those with multifocal “small satellite Gleason 6 lesions in the presence of a larger index lesion,” it is possible to consider focal ablation of the index lesion as an option.
They concurred that whole-gland treatment should be considered for high-grade, large volume PCa, or “in young men with evidence of high-volume multifocal low-grade prostate cancer.”
In their conclusion, they issued a standard concern that larger, randomized prospective clinical trials are needed to demonstrate the benefits of focal therapy, but their article is essentially a green light for focal therapy in carefully qualified patients. Recognizing that not everyone with low risk PCa will have the psychological tolerance for active surveillance, the authors state, “With improved imaging, focal therapy may be an option for patients not choosing active surveillance with low-risk disease, progression upon active surveillance or intermediate-risk cancers with a localizable lesion.” In short, this article is good news for our Center, which offers advanced 3T multiparametric MRI for top-level prostate imaging, and image-guided focal laser ablation (FLA) for treating cases such as the panel describes.
[ii] Van der Poel H, Klotz L, Andriole G, Azzouzi AR et al. Role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers. World J Urol. 2015 Jul;33(7):907-16. doi: 10.1007/s00345-015-1603-7. Epub 2015 Jun 3.