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Current status and future prospective of focal therapy for localized prostate cancer: development of multiparametric MRI, MRI-TRUS fusion image-guided biopsy, and treatment modalities

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Abstract

Multiparametric magnetic resonance imaging (mpMRI) has been increasingly used to diagnose clinically significant prostate cancer (csPC) because of its usefulness in combination with anatomic and functional data. MRI-targeted biopsy, such as MRI-transrectal ultrasound (TRUS) fusion image-guided prostate biopsy, has high accuracy in the detection and localization of csPC. This novel diagnostic technique contributes to the development of tailor-made medicine as focal therapy, which cures the csPC while preserving the anatomical structures related to urinary and sexual function. In the early days of focal therapy, TRUS-guided systematic biopsy was used for patient selection, and treatment was performed for patients with low-risk PC. With the introduction of mpMRI and mapping biopsy, the treatment range is now determined based on individualized cancer localization. In recent prospective studies, 87.4% of treated patients had intermediate- and high-risk PC. However, focal therapy has two main limitations. First, a randomized controlled trial would be difficult to design because of the differences in pathological features between patients undergoing focal therapy and radical treatment. Therefore, pair-matched studies and/or historical controlled studies have been performed to compare focal therapy and radical treatment. Second, no long-term (≥ 10-year) follow-up study has been performed. However, recent prospective studies have encouraged the use of focal therapy as a treatment strategy for localized PC because it contributes to high preservation of continence and erectile function.

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Acknowledgements

The present study was supported by the Takeda Science Foundation.

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Authors and Affiliations

  1. Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan

    Sunao Shoji, Izumi Hanada, Hakushi Kim, Masahiro Nitta, Masanori Hasegawa, Yoshiaki Kawamura & Akira Miyajima

  2. Department of Pathology, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, 192-0032, Japan

    Shinichiro Hiraiwa & Takuma Tajiri

  3. Department of Radiology, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, 192-0032, Japan

    Kazunobu Hashida

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  1. Sunao Shoji
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  2. Shinichiro Hiraiwa
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Correspondence to Sunao Shoji.

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Shoji, S., Hiraiwa, S., Hanada, I. et al. Current status and future prospective of focal therapy for localized prostate cancer: development of multiparametric MRI, MRI-TRUS fusion image-guided biopsy, and treatment modalities. Int J Clin Oncol 25, 509–520 (2020). https://doi.org/10.1007/s10147-020-01627-8

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