Imaging and Focal Therapy of Early Prostate Cancer

This book encompasses an up-to-date, comprehensive review of the state-of-the-art for prostate gland preserving therapies. It provides insight into the latest research and clinical applications of image-guided diagnosis and minimally invasive focal, gland-preserving treatment for prostate cancer. Fully updated and revised, this text evaluates the scientific evidence for the evolving trend to treat intermediate risk, clinically localized prostate cancer in a focally ablative manner with novel gland-preserving, image-targeted therapy methods.

Imaging and Focal Therapy of Early Prostate Cancer, Third Edition opens with a discussion of why patients and clinicians should consider focal therapy, then moves on to consider the question of active surveillance versus focal therapy from a global perspective, with chapters on North American, European, Southeast Asian, and South American perspectives. From there, chapters cover the scientific foundation of focal therapy, current and new approaches to image cancer foci within the prostate (multiparametric ultrasonography, multiparametric magnetic resonance imaging, etc.) and various biopsy techniques. Following this is detailed coverage of patient selection, treatment strategy, adjuvants to enhance therapy, outcomes, and patient centered interests, followed by a discussion of the strengths and limitations of various therapeutic modalities, such as cryotherapy, high intensity focused ultrasound, and photodynamic therapy, follows. The final sections of the book cover the assessment of focal therapy outcomes and look forward to the future of focal therapy for prostate cancer.

Written by experts in the field and lavishly illustrated with detailed line-art and photographs, this text is designed as a comprehensive resource for urologists, radiation oncologists, medical oncologists, radiologists, uropathologists, molecular biologists, biomedical engineers, residents, fellows, nurses and allied professionals, and researchers with an interest in the diagnosis and novel targeted treatment of prostate cancer.

Part I.  Why Consider Focal Therapy?.- 1. What is Focal Therapy for Prostate Cancer? A Guide for Patients.- 2. Evolution of Focal Therapy for Localized Breast Cancer: Lumpectomy.- 3. Image-targeted Therapy for Localized Kidney Cancer.- 4. The Patient’s Perspective: What Does the Patient Want? .- Part II. Global Perspective of Active Surveillance (AS) and Focal Therapy (FT) .- 5. Intersection of AS and Radical Therapy: Opportunities for FT in North America..- 6. FT and AS of Prostate Cancer - A European Perspective.- 7. FT and AS of Prostate Cancer in Southeast Asia and the East.- 8. FT Perception and Acceptance in South America.- Part III.  The Focal Therapy Concept: Scientific Foundation.- 9. Understanding Tumor Biology and Pathology - Cancer Grade, Volume, and Spatial Location – as a Foundation for Focal Therapy.- 10. Identifying and Characterizing the Index Lesion.- 11. The Role of Molecular Techniques to Distinguish Low Grade from Lethal Cancers.- 12. Utilizing Biopsy-based Genomic Assays to Risk Stratify Patients for Active Treatment.- 13.  Can Understanding and Utilizing the Tumor Microenvironment Enhance the Therapeutic Efficacy of FT? .- 14. Differences between MRI Visible vs Invisible Cancers: Biology and Outcomes.- Part IV.  Prostate Imaging and Staging.- 15. PIRADS Reporting Standards and Limitations for Cancer Detection in the Peripheral Zone vs Transition Zone, PI-QUAL, and Standardization in MR Quality.- 16. Employing a Quality Improvement Program to Optimize mpMRI-directed Fusion Biopsy.- 17. Multiparametric Ultrasound for Prostate Imaging and Targeting.- 18. What is Necessary for FT Staging: Cross-sectional vs PET vs Nil?.- Part V.  Image-Targeted Prostate Biopsy Techniques.- 19. mpMRI-TRUS Prostate Fusion Biopsy Commercial Systems.-20. Comparison of Outcomes with Transperineal vs Transrectal Image-targeted Prostate Biopsy.- 21. Using Multicore, Transperineal Prostate Mapping Biopsy to Detect, Localize and Treat the mpMRI Invisible Lesion.- 22. Multi-parametric Ultrasound (mpUS) Biopsy.- 23. Diagnostic Performance of PET-based Targeted Fusion Biopsy in Prostate Cancer.- 24. Optimizing biopsy core quality for diagnosis.- Part VI.  Patient Selection and Ablation Treatment Schema.- 25. Patient Selection: What Tumors Should Be Treated Based on Grade, Size, Location, Genetics and Risk Category?.- 26. Definitions and Common Terminology for Focal Prostate Ablation.- 27. Focal Therapy for Anterior Cancers.- 28. Office-based Outpatient Focal Therapy.- Part VII.  Transperineal Technologies for Focal Therapy.- 29. Focal Brachytherapy and IMRT.- 30. In-bore Transperineal MRI-Guided Laser Ablation.- 31. Focal Cryoablation.- 32. Irreversible Electroporation for Partial Gland Ablation: Clinical Application and Outcomes.- 33. Photodynamic Therapy.- Part VIII.  Transurethral Technologies for Focal Therapy.- 34. Role of TULSA as a Focal Therapy in Prostate Cancer.- 35. Transurethral Vapor Ablation in Prostate Cancer.- Part IX.  Transrectal Technologies for Focal Therapy.- 36. Robotic High-Intensity Focused Ultrasound.- 37. Transrectal laser ablation of prostate cancer.- Part X.  Post-treatment Assessment of Focal Therapy Outcomes.- 38. Role of Prostate MRI for Post-treatment Assessment and Surveillance.- 39. Measuring patient-based outcomes: setting realistic expectations when balancing functional outcomes with cancer control.- 40. Assessing Functional Outcomes after Focal Therapy.- 41. Biochemical Assessment of Cancer Outcomes following Focal Therapy.- 42. Pathologic Assessment and Implications following Prostate Focal Therapy.- 43. Salvage Options after Focal Therapy Recurrence.- Part XI. Looking forward.- 44. Design of Payment and Reimbursement Strategies for Focal Therapy for Acceptance in Value Based Care Models.- 45. The Horizon: Future of Focal Therapy in Prostate Cancer.

Thomas J. Polascik, MD FACS is the Lawrence C. Katz Distinguished Professor of Urologic Surgery and Professor of Radiology, Duke University Medical Center.  He is the Director of Surgical Technology, Duke Prostate and Urological Cancer Center. He is the co-founder and co-director of the International Symposium on Focal Therapy and Imaging of Prostate and Kidney Cancer, which began at Duke in 2008. Dr Polascik is the Editor of the text Imaging and Focal Therapy of Early Prostate Cancer, now in its third edition. He currently is the founder and immediate past President of the Focal Therapy Society, Duke’s Genitourinary Program on Focal Therapy and the founding and past Director of the Society of Urologic Oncology fellowship training program at the Duke Cancer Institute.  He is the Medical Director of Duke Men’s Health Initiative Screening event each June and is a governing member of several medical boards and societies.  His clinical and research interests focus on prostate and kidney cancer.  He has authored over 400 peer-reviewed manuscripts and book chapters.

Dr de la Rosette is Professor of Urology, at Istanbul Medipol Mega University Hospital, Istanbul, Turkey since 2018. Upon completion of his medical degree and urology residency at St Radboud University Hospital in Nijmegen, the Netherlands he worked there as urologists from 1992 - 2002. He was appointed Professor and Chair at the department of urology at Amsterdam UMC, Amsterdam, the Netherlands from 2002-2020. His main fields of interest are minimal invasive surgery and endourology with a special focus on ablative treatments and urological ultrasound.  He is founding co-chairman of the EAU Section of Uro-Technology (ESUT) and the founding chairman of the European Association of Urology (EAU) working party on BPH guidelines. He served as board member of the Society of Endourology during 1996-2016. He is strongly committed to research and is the founding-chair of the CROES (Clinical Research Office of the Endourology Society). He held since 2016 the position of General Secretary of the Societe International d'Urologie and is since 2023 the President Elect of the Societe International d'Urologie. Dr de la Rosette is (co)author of over 750 peer-reviewed publications and has authored many book chapters.

Rafael Sanchez-Salas

McGill University

Department of Surgery, Division of Urology

Montreal, Quebec

Canada

Ardeshir R. Rastinehad

Northwell Health System

Smith Institute for Urology at Lenox Hill

New York, USA