Focal Therapy for Prostate Cancer in Italy

On the occasion of the Italian Society of Urology 91st Annual Congress, the promising results of focal therapy for prostate cancer in Italy were presented by local scientists.

Innovative treatment will soon be available in specialized urology centers.

Leading Italian hospitals, such as European Institute of Oncology, are introducing a minimally invasive treatment technique for early stage prostate cancer.

Focal therapy is based on the high-precision effect of physical factors on malignant tissue with preservation of the gland.

Some of the recommended clinics for prostate cancer treatment in Italy:

• European Institute of Oncology (Macconago)
• Fondazione IRCCS Istituto Nazionale dei Tumori (Milan)
• ASST Papa Giovanni XXIII (Bergamo)
• San Giovanni di Dio Hospital (Argigento)
• Conegliano Hospital (Conegliano)
• Ospredale di Sanremo (Sanremo)
• Policlinico A. Gemelli (Rome)
• Policlinico di Catania (Catania)

The last achievement of Italian oncologists is tumor-targeted photodynamic therapy using a low-power non-thermal laser (laser non termico).

A similar treatment method is currently undergoing clinical trials in the United States. The PDT procedure offers inoperable elderly patients many advantages over traditional radical surgery, including reducing the risk of serious complications.

The details of innovative approach were discussed at the SIU congress in Riccione.

The basic principles and methods of focal therapy

This method of treatment has long been studied in Europe and the United States to enable men with small, localized tumors to avoid traditional prostatectomy.

The goal of focal therapy is to effectively control prostate cancer without the painful and debilitating surgical complications.

The advantages of the new method are impressive:

• Selective destruction of malignant tissue
• Maximum preservation of the prostate gland structures
• Preservation of the nerve supply and sexual function
• Outpatient (ambulatory) cancer treatment
• Medical costs reduction

Each medical institution develops its own approach to focal therapy for prostate cancer.

For example, Memorial Sloan Kettering Cancer Center in the USA is working on high-intensity focused ultrasound (HIFU), which is very effective against solid tumors.

Some university clinics in Germany, as well as Italian oncologists, today focused on the undeveloped opportunities of photodynamic therapy (PDT).

After these experimental procedures, all patients will continue to be monitored.

In particular, follow-up includes regular scans, prostate biopsies and PSA lab tests.

There are some approaches to focal therapy for prostate cancer:

• Cryoablation of the prostate. A minimally invasive procedure when doctor inserts a thin probe into a tumor, which freezes it with liquid nitrogen. As a result, a significant percentage of normal tissue can be saved during a surgery.
• Laser ablation of the prostate. The method is based on direct cauterization of the tumor with a powerful laser under the control of magnetic resonance imaging.
• Tumor-targeted photodynamic therapy based on the photodynamic effect. Before the procedure, the patient is given a photosensitizing agent. Drug is quickly distributed in the malignant tissue, after which the tumor is irradiated with a non-thermal laser.
• High-intensity focused ultrasound. HIFU uses high energy ultrasound waves, which are sent directly to the tumor under magnetic resonance imaging (MRI) guidance. Ultrasound induces overheating of malignant cells, preserving the surrounding prostate tissue.
• Irreversible electroporation (IRE). Known as NanoKnife, this modern technology uses electrical current under US or CT guidance. An electric charge breaks microscopic pores in cells, destroying cancer (this is why the procedure is called electroporation).

The first experience of focal therapy for prostate cancer in Italy

According to the researchers, photodynamic therapy (la terapia fotodinamica) reduces localized stage I tumors making possible active surveillance, and also reduces the risk of developing higher grade tumors. The necrosis resulting from exposure to light does not affect healthy tissue.

A clinical trial of PCM301 (details were presented in Riccione) showed that PDT significantly increases the relapse-free survival rate for prostate cancer, slowing the tumor growth. This method is especially suitable for men who cannot undergo surgical treatment for medical reasons.



Other advantages of the new minimally invasive treatment are the reduction of procedure time (which is now only one and a half hours in the operating room) and the outpatient treatment.

This leads to a decrease in emotional stress caused by complications of prostatectomy and long courses of conservative therapy. A significant improvement in quality of life, preservation of sexual function, pain reduction, and faster urine flow normalization are clear advantages of PDT. Some experts think that radical surgery is compromised by slow recovery and painful permanent complications. Although prostatectomy radically solves the problem, it does not suit every man.

Giuseppe Morgia from Societa Italiana di Urologia confirmed that PDT is only suitable for patients diagnosed at an early cancer stage, being a valuable alternative to radical surgery.

In the next few years, routine focal therapy for prostate cancer in Italy using PDT will be available in the leading hospitals. The cost of innovative procedure is not yet known, but experts believe that the treatment will ultimately be much cheaper compared to the United States.

© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator