Whole-gland radiotherapy or prostatectomy for localised prostate cancer lead to excellent long-term cancer control and survival. Albeit often accompanied by side-effects such as urinary incontinence after prostatectomy, rectal side-effects after radiotherapy and, for both, erectile dysfunction. Focal therapy (FT) has been suggested as a treatment which, in a subgroup of patients, could lead to durable cancer control while reducing side-effects. This concept has increasingly been investigated in recent years. Arguments against focal therapy are the primary multifocality often observed in prostate cancer and potential understaging of clinically significant disease.
For patients with locally recurrent prostate cancer after primary radiotherapy, focal salvage treatment is potentially even more attractive compared to the primary setting due to the more often unifocal nature of the recurrent cancer. Whole-gland salvage treatments (e.g. radiotherapy, prostatectomy, cryotherapy, HIFU) are associated with high rates of severe toxicity and are, therefore, uncommonly performed. Focal salvage with differing modalities seems to reduce these toxicity risks, while maintaining cancer control in a substantial group of patients.
The goal of this Research Topic would be to give an overview of aspects of diagnosis and clinical outcomes of focal primary and focal salvage treatment, including future perspectives. Arguments against primary focal therapy focus on the multifocality of prostate cancer and the inability of current imaging and biopsy modalities to accurately stage all clinically significant cancer foci. Interesting projects regarding the diagnosis of the so-called index lesion, potentially with whole-mount histology as reference standard, would be of interest for this issue. The combination with clinical data on different focal treatment modalities would be even better. Clinical trials in the making or running, investigating different aspects of primary focal therapy, additionally fit in this Research Topic.
Primary focal therapy is investigated in quite large studies already. Focal salvage after radiotherapy failure is investigated less. Articles regarding the diagnosis of recurrent lesions, pathology aspects due to radiotherapy effects and studies on clinical outcomes of different focal salvage approaches hold value for this issue. Additionally, as in primary focal therapy, upcoming or running trials are of interest.
Of special interest are recent advances in radiation techniques enabling non-invasive focal salvage such as SBRT, potentially MRI guided. Advances in diagnostic imaging such as PSMA-PET CT in combination with multiparametric MRI and pathology are also of interest. Overviews of clinical results of different primary focal and salvage modalities are also welcome. Because these have been performed on several occasions already, combinations with new techniques such as (MRI-guided) SBRT or new diagnostic combinations, are preferred. Overviews of running trials, upcoming trials and the like are welcome to be submitted.
Please note: manuscripts consisting solely of bioinformatics or computational analysis of public genomic or transcriptomic databases which are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) are out of scope for this section and will not be accepted as part of this Research Topic.
Whole-gland radiotherapy or prostatectomy for localised prostate cancer lead to excellent long-term cancer control and survival. Albeit often accompanied by side-effects such as urinary incontinence after prostatectomy, rectal side-effects after radiotherapy and, for both, erectile dysfunction. Focal therapy (FT) has been suggested as a treatment which, in a subgroup of patients, could lead to durable cancer control while reducing side-effects. This concept has increasingly been investigated in recent years. Arguments against focal therapy are the primary multifocality often observed in prostate cancer and potential understaging of clinically significant disease.
For patients with locally recurrent prostate cancer after primary radiotherapy, focal salvage treatment is potentially even more attractive compared to the primary setting due to the more often unifocal nature of the recurrent cancer. Whole-gland salvage treatments (e.g. radiotherapy, prostatectomy, cryotherapy, HIFU) are associated with high rates of severe toxicity and are, therefore, uncommonly performed. Focal salvage with differing modalities seems to reduce these toxicity risks, while maintaining cancer control in a substantial group of patients.
The goal of this Research Topic would be to give an overview of aspects of diagnosis and clinical outcomes of focal primary and focal salvage treatment, including future perspectives. Arguments against primary focal therapy focus on the multifocality of prostate cancer and the inability of current imaging and biopsy modalities to accurately stage all clinically significant cancer foci. Interesting projects regarding the diagnosis of the so-called index lesion, potentially with whole-mount histology as reference standard, would be of interest for this issue. The combination with clinical data on different focal treatment modalities would be even better. Clinical trials in the making or running, investigating different aspects of primary focal therapy, additionally fit in this Research Topic.
Primary focal therapy is investigated in quite large studies already. Focal salvage after radiotherapy failure is investigated less. Articles regarding the diagnosis of recurrent lesions, pathology aspects due to radiotherapy effects and studies on clinical outcomes of different focal salvage approaches hold value for this issue. Additionally, as in primary focal therapy, upcoming or running trials are of interest.
Of special interest are recent advances in radiation techniques enabling non-invasive focal salvage such as SBRT, potentially MRI guided. Advances in diagnostic imaging such as PSMA-PET CT in combination with multiparametric MRI and pathology are also of interest. Overviews of clinical results of different primary focal and salvage modalities are also welcome. Because these have been performed on several occasions already, combinations with new techniques such as (MRI-guided) SBRT or new diagnostic combinations, are preferred. Overviews of running trials, upcoming trials and the like are welcome to be submitted.
Please note: manuscripts consisting solely of bioinformatics or computational analysis of public genomic or transcriptomic databases which are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) are out of scope for this section and will not be accepted as part of this Research Topic.
