Focal therapy is a promising option for selected patients who have localized low or intermediate-risk prostate cancer, providing a compelling alternative between active surveillance and radical therapies by targeting the index lesion and preserving as much tissue as possible. Numerous cohort studies have already investigated multiple focal techniques, such as cryotherapy, high-intensity focused ultrasound, brachytherapy, photodynamic therapy, laser therapy, irreversible electroporation and cyberknife methods, all of which have demonstrated positive oncological outcomes with 70 to 90 % negative follow-up biopsy. These various ablative techniques have produced only minor side-effects concerning urinary function, a low rate of erectile dysfunction, and have demonstrated a limited rectal toxicity. As a result, the primary end-point has now shifted and a new strategy needs to be established for patient follow-up and for defining treatment failure. Written by international experts in the field, this book is mainly focused on new techniques, all of which are amply illustrated. Technical Aspects of Focal Therapy in Localized Prostate Cancer will be of great practical value to all urologists and oncologists.

This book comprehensively reviews the potential of focal therapy and discusses why the changing face of prostate cancer warrants a change in the way we treat men with the disease. It deals with the mechanisms by which disease can be localized within the gland and then the different technologies used for focal ablation. Bringing together eminent contributors in one accessible reference, this book introduces focal therapy to all urologists, oncologists, and radiologists who are involved in the treatment of men with prostate cancer.

This book provides a 2015 state of the art update on the hot topic of focal prostate cancer therapy, which offers a means of preserving the prostate and avoiding major side-effects associated with conventional treatment strategies. In so doing, focal therapy meets the desire of many patients, especially those with low-risk disease, to avoid or postpone radical therapies in order to preserve quality of life. A wide range of aspects are covered, including the role of imaging-guided targeted biopsies, the pros and cons of surveillance in comparison with focal therapy, focal hemiablation and focal salvage therapy, multifocal therapies, focal cryotherapy. The potential role of various new diagnostic technologies as well as specific therapeutic devices as "Focal.One" robotic high-intensity focused ultrasound are explained. The authors are all international experts who are long-term proponents of non-invasive treatment of prostate cancer. "Focal Therapy of Prostate Cancer" will be an invaluable source of information for urologists, oncologists, radiation oncologists, and general practitioners, and also for patients wishing to learn more about this new treatment option.

Prostate cancer is the commonest cancer in men. Current treatments include surgery to remove the whole prostate or radiotherapy of the whole prostate. These radical treatments can treat the cancer effectively but often cause unwanted side effects. Meanwhile widespread screening with prostate-specific antigen has led to an increased diagnosis of localised prostate cancer; at the same time, widespread use of abdominal imaging has led to increased detection of renal masses. In response to demand for improved outcomes with reduced side effects, focal therapy has emerged as an important procedure in managing both prostate and renal cancers. It targets individual areas of cancer, reducing unwanted side effects and the amount of damage to collateral tissue. This new method of treatment has major advantages: it involves less radiation, the removal of less tissue and less time spent in hospital. Handbook of Focal Therapy for Prostate and Renal Cancer provides a comprehensive, timely review of targeted ablation methods to treat prostate and renal cancers. It describes the most effective techniques in current practice, with discussion of the selection criteria, ablation technologies and their limitations, and advice on the management of common side effects. The book opens with a summary of the principles of prostate and renal cancer treatment and the mechanisms of focal therapy. Separate sections on prostate and kidney follow, covering the role of focal therapy, side effects and their treatment and follow-up after targeted ablation. Written in a practical, clinically-oriented style, Handbook of Focal Therapy for Prostate and Renal Cancer is the ideal reference for urologists, radiologists and radiation oncologists wishing to employ the latest focal therapy techniques in the care of their patients.

This text encompass an up-to-date, comprehensive review of the state-of-the-art for gland preserving therapies. Fully updated and revised, this text evaluates the scientific evidence for the evolving trend to treat intermediate risk, clinically localized prostate cancer in a focally ablative manner with novel gland-preserving, focal therapy methods. Various ablative devices such as high intensity focused ultrasound, irreversible electroporation, photodynamic therapy, cryotherapy and laser ablation, among others, is discussed in regard to their strengths and limitations as a therapeutic modality. Emphasis is placed on patient selection and outcomes utilizing both advanced imaging techniques and pathologic evaluation. Current and new approaches to image cancer foci within the prostate (multiparametric ultrasonography, multiparametric magnetic resonance image, etc) are presented along with various biopsy techniques, including robotics to map prostate cancer. Patient selection based on imaging and genomic classification, adjuvants to enhance therapy, treatment strategy, outcomes and patient centered concerns is discussed, providing an acceptable balance between cancer control and improved quality of life for patients. Written by experts in the field and lavishly illustrated with detailed line-art and photographs, Imaging and Focal Therapy of Early Prostate Cancer, Second Edition is designed as a comprehensive resource for urologists, radiation oncologists, medical oncologists, radiologists, uropathologists, molecular biologists, biomedical engineers, other clinicians –- residents, fellows, nurses and allied professionals -- and researchers with an interest in the diagnosis and novel treatment of prostate cancer. It will provide insight into the latest research and clinical applications of image-guided diagnosis and minimally invasive focal, gland-preserving treatment for prostate cancer.

Non-thermal irreversible electroporation is a new minimally invasive surgical p- cedure with unique molecular selectivity attributes – in fact it may be considered the first clinical molecular surgery procedure. Non-thermal irreversible electro- ration is a molecular selective mode of cell ablation that employs brief electrical fields to produce nanoscale defects in the cell membrane, which can lead to cell death, without an effect on any of the other tissue molecules. The electrical fields can be produced through contact by insertion of electrode needles around the undesirable tissue and non-invasively by electromagnetic induction. This new - dition to the medical armamentarium requires the active involvement and is of interest to clinical physicians, medical researchers, mechanical engineers, che- cal engineers, electrical engineers, instrumentation designers, medical companies and many other fields and disciplines that were never exposed in their training to irreversible electroporation or to a similar concept. This edited book is designed to be a comprehensive introduction to the field of irreversible electroporation to those that were not exposed or trained in the field before and can also serve as a reference manual. Irreversible electroporation is broad and interdisciplinary. Therefore, we have made an attempt to cover every one of the various aspects of the field from an introductory basic level to state of the art.

Prostate cancer, a disease diagnosed in approximately 220,000 men in the U.S. annually, has historically been treated through extirpation of the entire gland. Unfortunately, whole-gland interventions exact a heavy toll, often resulting in incontinence and impotence. One proposed alternative is focal therapy, wherein MR-visible tumor foci are treated locally while sparing the majority of healthy tissue. This approach has great potential to deliver curative treatment while reducing costs and risks. In order to demonstrate the safety, efficacy, and practicality of focal therapy, several key questions remain: 1. How reliably can tumor location be distinguished? 2. What treatment margins are necessary? 3. Can treatment be delivered safely in a clinic setting? This thesis presents a concerted effort to answer these questions, guided by the central hypothesis that focal therapy can be made safe and effective by registering MRI with ultrasound, pathology, and thermal data. To this end, we characterized and clinically implemented a means of accurately correlating MRI with histopathology. We discovered that many tumors extend far beyond the confines of MR-visibility, and the average tumor was three times its predicted volume. Isotropic margins in excess of 1 cm would have been necessary to treat the majority of focal therapy eligible men. However, by registering tracked biopsy data with MRI, we demonstrated that patient-specific treatment margins can greatly improve cancer prediction. We performed clinical trials investigating the safety of focal laser ablation (FLA) of prostate cancer, a modality wherein an interstitial laser delivers thermal energy and induces coagulative necrosis. Through analysis of MRI thermometry data, we found that thermal damage could be predicted with less than 15% volumetric error (0.5 cc). In a second clinical trial, FLA was performed under the guidance of MRI-US fusion imaging. This trial demonstrated that focal therapy could be performed safely, in a clinic setting, and without risk of incontinence or impotence. Furthermore, clinically significant cancer was eliminated from 60% of men, demonstrating the potential efficacy of localized treatment. Future work is necessary to refine all aspects of prostate focal therapy. However, this thesis lays a foundation for safe and effective treatment of localized prostate cancer.