scholarly journals Focal Treatment of Prostate Cancer with Vascular-Targeted Photodynamic Therapy

2008 ◽  
Vol 8 ◽  
pp. 963-973 ◽  
Author(s):  
Scott E. Eggener ◽  
Jonathan A. Coleman
Keyword(s):  
Prostate Cancer ◽  
Photodynamic Therapy ◽  
Focal Therapy ◽  
Attractive Alternative ◽  
Screening Programs ◽  
Sexual Side Effects ◽  
Pathologic Features ◽  
Focal Treatment ◽  
Risk Of Progression ◽  
Targeted Photodynamic Therapy

Epidemiologic and pathologic features of prostate cancer have given rise to an interest in focal treatment for carefully selected patients. Prostate cancer remains highly prevalent, particularly in the U.S. and Europe. As screening programs have become more aggressive and widespread, a substantial proportion of men diagnosed with localized prostate cancer have disease characteristics associated with a low risk of progression. Treatments such as radical prostatectomy and radiation therapy can lead to durable recurrence-free survival in most patients, but carry variable risks of bowel, urinary, and sexual side effects. Few men and few urologists are comfortable leaving a potentially curable prostate cancer untreated. Focal therapy offers an attractive alternative for the patient faced with a choice between aggressive local intervention (radiation or surgery) and watchful waiting. Contemporary diagnostic biopsy strategies and imaging tools, and the development of predictive statistical models (nomograms), have led to improvements in tumor characterization and risk stratification, making focal therapy a viable treatment option for specific men. This article reviews the rationale and indications for focal therapy and highlights vascular-targeted photodynamic therapy (PDT) as one of many promising focal therapy techniques.

scholarly journals Tumour irradiation combined with vascular-targeted photodynamic therapy enhances antitumour effects in pre-clinical prostate cancer

2021 ◽  
Author(s):  
Hanna T. Sjoberg ◽  
Yiannis Philippou ◽  
Anette L. Magnussen ◽  
Iain D. C. Tullis ◽  
Esther Bridges ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Photodynamic Therapy ◽  
Vascular Function ◽  
Multimodality Treatment ◽  
Focal Therapy ◽  
Tumour Microenvironment ◽  
Fractionated Radiotherapy ◽  
Tumour Control ◽  
Early Phase Clinical Trials ◽  
Targeted Photodynamic Therapy

Abstract Background There is a need to improve the treatment of prostate cancer (PCa) and reduce treatment side effects. Vascular-targeted photodynamic therapy (VTP) is a focal therapy for low-risk low-volume localised PCa, which rapidly disrupts targeted tumour vessels. There is interest in expanding the use of VTP to higher-risk disease. Tumour vasculature is characterised by vessel immaturity, increased permeability, aberrant branching and inefficient flow. FRT alters the tumour microenvironment and promotes transient ‘vascular normalisation’. We hypothesised that multimodality therapy combining fractionated radiotherapy (FRT) and VTP could improve PCa tumour control compared against monotherapy with FRT or VTP. Methods We investigated whether sequential delivery of FRT followed by VTP 7 days later improves flank TRAMP-C1 PCa tumour allograft control compared to monotherapy with FRT or VTP. Results FRT induced ‘vascular normalisation’ changes in PCa flank tumour allografts, improving vascular function as demonstrated using dynamic contrast-enhanced magnetic resonance imaging. FRT followed by VTP significantly delayed tumour growth in flank PCa allograft pre-clinical models, compared with monotherapy with FRT or VTP, and improved overall survival. Conclusion Combining FRT and VTP may be a promising multimodal approach in PCa therapy. This provides proof-of-concept for this multimodality treatment to inform early phase clinical trials.

Focal treatment of prostate cancer with vascular-targeted photodynamic therapy

2011 ◽  
Vol 8 (2) ◽  
pp. 174
Author(s):  
S. Mordon ◽  
P. Colin ◽  
N. Betrouni ◽  
N. Makni ◽  
P. Nevoux ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Photodynamic Therapy ◽  
Focal Treatment ◽  
Targeted Photodynamic Therapy

scholarly journals Magnetic Resonance–Guided Prostate Ablation

2019 ◽  
Vol 36 (05) ◽  
pp. 351-366
Author(s):  
David A. Woodrum ◽  
Akira Kawashima ◽  
Krzysztof R. Gorny ◽  
Lance A. Mynderse
Keyword(s):  
Prostate Cancer ◽  
Prediction Models ◽  
Focal Therapy ◽  
The United States ◽  
Management Approach ◽  
Low Grade ◽  
Intermediate Risk ◽  
Screening Programs ◽  
Risk Prostate Cancer ◽  
Prostate Cancers

AbstractIn 2019, the American Cancer Society (ACS) estimates that 174,650 new cases of prostate cancer will be diagnosed and 31,620 will die due to the prostate cancer in the United States. Prostate cancer is often managed with aggressive curative intent standard therapies including radiotherapy or surgery. Regardless of how expertly done, these standard therapies often bring significant risk and morbidity to the patient's quality of life with potential impact on sexual, urinary, and bowel functions. Additionally, improved screening programs, using prostatic-specific antigen and transrectal ultrasound-guided systematic biopsy, have identified increasing numbers of low-risk, low-grade “localized” prostate cancer. The potential, localized, and indolent nature of many prostate cancers presents a difficult decision of when to intervene, especially within the context of the possible comorbidities of aggressive standard treatments. Active surveillance has been increasingly instituted to balance cancer control versus treatment side effects; however, many patients are not comfortable with this option. Although active debate continues on the suitability of either focal or regional therapy for the low- or intermediate-risk prostate cancer patients, no large consensus has been achieved on the adequate management approach. Some of the largest unresolved issues are prostate cancer multifocality, limitations of current biopsy strategies, suboptimal staging by accepted imaging modalities, less than robust prediction models for indolent prostate cancers, and safety and efficiency of the established curative therapies following focal therapy for prostate cancer. In spite of these restrictions, focal therapy continues to confront the current paradigm of therapy for low- and even intermediate-risk disease. It has been proposed that early detection and proper characterization may play a role in preventing the development of metastatic disease. There is level-1 evidence supporting detection and subsequent aggressive treatment of intermediate- and high-risk prostate cancer. Therefore, accurate assessment of cancer risk (i.e., grade and stage) using imaging and targeted biopsy is critical. Advances in prostate imaging with MRI and PET are changing the workup for these patients, and advances in MR-guided biopsy and therapy are propelling prostate treatment solutions forward faster than ever.

Focal Therapy of Prostate Cancer by Radiofrequency and Photodynamic Therapy

2013 ◽  
pp. 727-751
Author(s):  
Bob Djavan ◽  
Herbert Lepor ◽  
Reza Zare ◽  
Seyed Saeid Dianat
Keyword(s):  
Prostate Cancer ◽  
Photodynamic Therapy ◽  
Focal Therapy

scholarly journals Decision Regret and Quality of Life after Focal Therapy with Vascular-Targeted Photodynamic Therapy (TOOKAD®) for Localized Prostate Cancer

2021 ◽  
pp. 1-6
Author(s):  
Luka Flegar ◽  
Martin Baunacke ◽  
Bjoern Thorben Buerk ◽  
Rick Proschmann ◽  
Aristeidis Zacharis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Decision Making ◽  
Photodynamic Therapy ◽  
Local Recurrence ◽  
Post Treatment ◽  
Decision Regret ◽  
Targeted Photodynamic Therapy ◽  
Decisional Regret

<b><i>Purpose:</i></b> The aim of the study was to assess quality of life (QoL), decision involvement, and decisional regret after treatment with vascular-targeted photodynamic therapy (VTP) (TOOKAD®) for unilateral low-risk prostate cancer. <b><i>Methods:</i></b> Validated questionnaires (EORTC QLQ-C30 and QLQ-PR25) capturing QoL post-treatment, involvement in decision-making (Control Preferences Scale) and decision regret (Decisional Regret Scale), were given to patients at the 12-month visit after undergoing VTP at our institution between May 2018 and February 2021. <b><i>Results:</i></b> Out of 44 patients, 36 patients were included in this study and 31 (86.1%) responded to the questionnaires. Mean overall health score capturing QoL at 12 months was 79.3 (standard deviation: ±18.1). 70.9% of the patients (<i>n</i> = 22) had no decision regret, and 67.8% of men (<i>n</i> = 21) had an active role in decision-making. In control biopsy at 12 months post-treatment, 19.4% of patients (<i>n</i> = 7) presented with local recurrence and progression to higher Gleason score (GS) was found in 13.8% of patients (<i>n</i> = 5). Patients (<i>n</i> = 3) presenting with tumor recurrence or progression to higher GS in control biopsy showed a significantly higher level of decision regret (<i>p</i> &#x3c; 0.009). <b><i>Conclusion:</i></b> Only 9.7% of men (<i>n</i> = 3) felt a strong emotion of regret at 12 months after VTP. Level of decision regret was significantly higher in patients with local recurrence or tumor progression detected in control biopsy. QoL was stable after VTP.

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