ESUI 2014

Will image guided therapy in prostate cancer become a standard in prostate cancer management?

Point and counterpoint:Yes it will vs. No, it will not

During the 3rd EAU Section of Urological Imaging (ESUI)meeting, which will be held on the 13th of November in Lisbon in conjunction with the 2014 EMUC meeting, the topic of imaging for prostate cancer in diagnosis and treatment will be extensively addressed. In the session entitled“Is MRI the best imaging tool for prostate cancer management?”a point and counterpoint discussion will focus on focal therapy of prostate cancer. This discussion will involve two key opinion leaders in the field of prostate cancer management. Both will highlight their point of view on focal therapy.

The current controversy in this field is obvious as prostate cancer is, in the vast majority of cases, a multifocal disease. The current rationale of true focal therapy is to ablate the prostate cancer index lesion only. Such a lesion is supposed to be the largest and less differentiated lesion and the lesion responsible for disease prognosis and development of metastasis. This rationale is supported by genetic studies suggesting that metastasis originate from one single cancer focus only, the index lesion. With true focal therapy of prostate cancer, other non-index lesions are left untouched and followed by observation inside of an active surveillance approach. Hashim Udin Ahmed from London is a strong supporter of this point of view and will take the point in favor of focal therapy to become a standard in prostate cancer management. On the other hand, this point of view is challenged by studies that show that metastasis show variable genetic profiles suggesting origins from several cancer foci. Moreover, there are genetic studies showing that metastasis do not necessarily derive from the index lesion but may originate from smaller non-index lesions instead. Based on this point of view a true focal therapy approach will result in insufficient and unsatisfactory treatment. Alberto Briganti from Milan is a supporter of this point of view and will take the point against focal therapy to become a standard in prostate cancer management.

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