Details

Autor(en) / Beteiligte

• Maroni, Paul D
• Crawford, E. David

Titel

The challenge of comparing investigative approaches to prostate cancer

Ist Teil von

• Oncology (Williston Park, N.Y.), 2008-07, Vol.22 (8), p.907

Ort / Verlag

Monmouth Junction: Intellisphere, LLC

Erscheinungsjahr

2008

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• The article by Polascik and coau- thors provides a timely synopsis of modem technologic advances in prostate cryoablation and a review of the rationale for and experience with targeted prostate treatments. Prostate cryoablation has a storied past, which can be briefly summarized as high excitement followed by near-com- plete abandonment. Fortunately, a few practitioners improved the technique and incorporated new technologies allowing for its resurrection. The au- thors mention a few improvements in a third-generation device, but numerous others have made prostate cryoablation much more safe and user-friendly, most notably the improvement in transrectal ultrasound imaging. The hope is that with larger cohorts and/or prospective studies this procedure will be on par with the mainstays of treatment for clinically localized prostate cancer. First, with the phenomena of multifocality and indolence, are all tumors clinically significant and therefore requiring treatment? The importance of determining biologic potential cannot be overemphasized, but this creates practical problems in outcomes research. Barring a major unanticipated advance, prostate-specific antigen (PSA) measurement and repeat prostate biopsy will almost certainly be the means by which oncologic efficacy will be assessed, provided these technologies are to be approved by an organization such as the US Food and Drug Administration. PSA will be a poor indicator, as significant portions of the prostate gland remain intact in targeted treatments. How can oncologic efficacy be assessed if a patient's initial multifocality or laterality is poorly understood? This would seemingly require that only hemiablation or targeted treatment be performed on patients with known unilateral disease, and most current staging modalities are insufficient for assessing this approach.