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MRI-guided focal therapy of prostate cancer


With the advent of focal therapy as a recognized treatment option for men with prostate cancer, there are a host of emerging interventions that take advantage of MRI for image guidance. Focal therapy affords a middleground option for patients with low- to intermediate-grade prostate cancer by providing a means of keeping their cancer at bay while avoiding the negative consequences of radical therapies. However, the practice of focal treatment is far from straightforward, with some believing focal treatment errs on the side of overtreatment among patients with low-grade cancer; others worry it is undertreatment in potentially significant multifocal disease. Further research is necessary, both relating to focal therapy in general and to the utility of each MRI-guided focal treatment discussed.

Prostate cancer is the most common noncutaneous malignancy among men and is a leading cause of death due to cancer among American males, second only to primary lung cancer [1]. According to data from the American Cancer Society, about one in seven men will contract prostate malignancy; however, most will not die from their cancer [2]. In fact, the most recent statistics state that the survival rate for prostate cancer (including all stages) is almost 100% at 5 years, 98% at 10 years and 95% at 15 years [3]. These data illustrate the inherent challenge of diagnosis and treatment of prostate cancer: along with detecting and effectively treating those individuals with potentially deadly disease, current and evolving tools should also be effective at differentiating such cases from instances of more indolent disease. With this conundrum solved, unnecessary procedures and treatments that would ultimately cause more harm than good can be avoided.

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