Focal therapy for prostate cancer 1996: maximizing outcome.

OBJECTIVES To summarize improvements in patient selection and the results of focal therapy for the management of localized prostate cancer. METHODS A contemporary series of patients managed with wide surgical excision, radiation therapy (three-dimensional conformal radiation, interstitial radiation, and charged-particle or proton therapy), and cryo-therapy were reviewed. RESULTS We used preoperative cancer grade, transrectal ultrasound, and serum prostate-specific antigen (PSA) in all patients, and cross-sectional imaging and bone scans in selected patients to allow for reasonably accurate cancer staging and selection of patients most likely to be cured by radical prostatectomy or radiation. In patients with extracapsular extension of prostate cancer, wide surgical excision and achievement of a clear surgical margin had therapeutic value. Newer radiation techniques resulted in a higher likelihood of prostate cancer control than previous techniques. Cryotherapy for patients with stages T1 through 3 prostate cancer was associated with a posttreatment undetectable PSA rate of 48% and a positive biopsy rate of 23%. CONCLUSIONS Patients with organ-confined and, therefore, curable prostate cancer can be identified. Well-performed radical prostatectomy, radiation, and cryotherapy are alternative treatments for the management of localized prostate cancer.