How to diagnose and treat focal therapy failure and recurrence?

作者：Barret Eric^*; Harvey Bryan Kadi Ann; Sanchez Salas Rafael; Rozet Francois; Galiano Marc; Cathelineau Xavier

来源：Current Opinion in Urology, 2014, 24(3): 241-246.

DOI：10.1097/MOU.0000000000000052

• biochemical recurrence
• focal therapy
• localized prostate cancer
• salvage focal therapy

Purpose of reviewFocal therapy presents an alternative option for disease-targeted therapy while preserving erectile and urinary function without compromising oncological outcome. Such treatment, which preserves normal prostate parenchyma, presents a clinical challenge to the urologist, as typical disease surveillance parameters are not as reliable in post-ablation follow-up. We propose an integrated approach to post-ablation surveillance to identify treatment failure as well as recurrence.Recent findingsPost-ablation prostate-specific antigen kinetics, imaging based on multiparametric MRI and control biopsies are the tools currently used to follow patients after focal therapy. Good treatment response is indicated by a negative control biopsy, absence of persistent lesion on post-treatment imaging and a reduction in prostate-specific antigen of at least 50%.SummaryWhen histological evidence of therapeutic failure or recurrence is present, different options of management may be proposed to the patient including active surveillance, focal salvage therapy or radical salvage treatment, depending on the characteristics of the lesion found. A recommended post-ablation surveillance protocol is presented as well as a discussion of management strategies based on the data currently available.

• 出版日期2014-5