“We’re starting to do some investigative studies on this, but it’s still premature to say whether it’s going to be the future.
For low-grade disease, it’s certainly worth a try because nothing is really lost. For high-grade disease, I don’t know that it’s appropriate—we don’t have the data.
It used to be that all grades of cancer were treated either by radiation or surgery. Now surveillance is preferred for low-grade cancer with close follow-up, including repeated prostate biopsies. Rather than having to do that, why not just do focal therapy—HIFU or cryosurgery? I’d rather follow up with PSAs than biopsies.
For the study, we’re doing MRI of the prostate and seeing which lesions are suspicious. If we see five suspicious lesions, we do biopsies, and for any that are positive, we can insert a probe and freeze that area of the prostate. If the biopsy of another lesion is negative, we don’t freeze it. Based on the biopsies, you know exactly where to put the probes to treat locally.
The problem is the data is still premature. I think there is a future to it. Perhaps it will be used to eliminate radiation therapy where you radiate the entire prostate. Why radiate the whole prostate if you can do focal therapy with cryosurgery?
Urologists and radiologists are going to get more proficient reading the MRIs and the MRIs are going to get better, so we can be more specific in finding prostate cancer. The first thing we have to determine is if prostate cancer, as a multifocal disease, exists in one part of the prostate, will it exist everywhere else in the prostate? We just don’t know about it because it hasn’t grown. That’s why we don’t know the long-term outcome.”
Boris Klopukh, MD