Multiparametric mri (mpmri): Guided focal therapy

Abstract

Approximately one in seven men will be diagnosed with prostate cancer during his lifetime. PSA screening has been blamed for increased rates of cancer detection, leading to subsequent overtreatment of disease. Overuse of definitive therapy has produced significant burdens, including excess costs, increasing patient morbidities, and decreased quality of life. Thus, there has been an increasing interest in minimally invasive focal therapies to treat prostate cancer. Advances in image-guided therapy have begun to emerge–utilizing the accurate tumor localization and improved disease staging of multiparametric MRI (mpMRI). MpMRI-guided therapies can potentially achieve equivalent oncologic efficacy to traditional whole gland therapies such as surgery and radiation, while avoiding the side effects of conventional treatment. The purpose of this chapter is to review briefly the basis of various focal therapy techniques such as cryotherapy, high intensity focused ultrasound, and laser interstitial therapy, and to discuss the results of recent clinical trials that demonstrate early outcomes in patients with prostate cancer treated with these methods.