Prostate Cancer: Navigating Focal Therapy Options

[Dr. Matt Cooperberg]:
There's this old saying that in surgical oncology, biology is king, and all the surgeons, and here you can throw in radiation oncologists and focal therapists and everybody else are the princess trying to overthrow the king, often to no avail. I think ultimately, it comes down to understanding the cancer more and more at the biological level. I think that the role for focal therapy is clearly going to grow as we can identify those tumors that are actually confined to the prostate, and we can visualize them with imaging, increasingly with functional imaging, as our focal modalities get more and more guided by real-time feedback from imaging.

Clearly, it makes sense. You look at the history, everyone always draws the analogy to breast cancer and lumpectomy, taking over from mastectomy. Obviously, there's a lot of different considerations in prostate compared to breast but nonetheless, the idea of treating the tumor rather than the prostate makes a lot of sense for a certain band of cancers. As we're able to identify that band, figure out the ones that need treatment and yet need less than total treatment and pelvic treatment, as we can identify those and target them, of course, the role here will continue to grow.

The only way we're going to identify those tumors is to take this seriously, to as we've said at the beginning, put patients that are undergoing focal therapy in a registry, on a trial, collect the data, be honest about our outcomes, and constantly be striving to improve those outcomes with research and improvements in our treatments.