FOCAL THERAPY FOR PROSTATE-CANCER 1996 - MAXIMIZING OUTCOME

Objectives. To summarize improvements in patient selection and the res ults of focal therapy for the management of localized prostate cancer. Methods. A contemporary series of patients managed with wide surgical excision, radiation therapy (three-dimensional conformal radiation, i nterstitial radiation, and charged-particle or proton therapy), and cr yotherapy were reviewed. Results. We used preoperative cancer grade, t ransrectal ultrasound, and serum prostate-specific antigen (PSA) in al l patients, and cross-sectional imaging and bone scans in selected pat ients to allow for reasonably accurate cancer staging and selection of patients most likely to be cured by radical prostatectomy or radiatio n. In patients with extracapsular extension of prostate cancer, wide s urgical excision and achievement of a clear surgical margin had therap eutic value. Newer radiation techniques resulted in a higher likelihoo d of prostate cancer control than previous techniques. Cryotherapy for patients with stages T1 through 3 prostate cancer was associated with a posttreatment undetectable PSA rate of 48% and a positive biopsy ra te of 23%. Conclusions. Patients with organ-confined and, therefore, c urable prostate cancer can be identified. Well-performed radical prost atectomy, radiation, and cryotherapy are alternative treatments for th e management of localized prostate cancer. (C) 1997 by Elsevier Scienc e Inc.