title: Targeted focal therapy for the management of organ confined prostate cancer.
abstract: OBJECTIVE
  Patients currently diagnosed with low risk prostate cancer are often overtreated and experience complications, resulting in detriment to quality of life. Targeted focal therapy is a minimally invasive procedure designed to ablate tumor foci while minimizing collateral damage to maintain quality of life.
  
  
  METHODS
  This institutional review board approved, prospective study was done to assess the safety and efficacy of targeted focal therapy using cryotherapy in men 40 to 85 years old diagnosed with low risk, organ confined prostate cancer at our institution between 2006 and 2009. Low risk, organ confined prostate cancer was defined as Gleason score 7 or less (3 + 4) on transrectal ultrasound biopsy, tumor burden 50% or less and prostate specific antigen less than 10 ng/dl. Patients were evaluated for eligibility after undergoing 3-dimensional mapping biopsy. Median followup was 28 months (IQR 26-31).
  
  
  RESULTS
  A total of 62 men with low risk disease met study inclusion criteria. At 1 year biopsy was negative in 50 of 62 patients (81%). All 12 men who tested positive on repeat biopsy had a Gleason score of 3 + 3 = 6 with 1 or 2 positive cores. The median prostate specific antigen change was a 3.0 ng/dl decrease (p <0.01). The median American Urological Association symptom score change was a 1.5-point decrease (p <0.01). No significant change was observed in Sexual Health Inventory for Men score (p = 0.6). No urinary incontinence episodes and no severe side effects were noted.
  
  
  CONCLUSIONS
  Targeted focal therapy in carefully selected patients provides a feasible, practical option for treating low risk prostate cancer with minimal impact on quality of life.
authors.affiliation: Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, Aurora, Colorado. Electronic address: al.barqawi@ucdenver.edu.
authors.forename: Al B
authors.initials: AB
authors.lastname: Barqawi
authors.affiliation: Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, Aurora, Colorado.
authors.forename: Diliana
authors.initials: D
authors.lastname: Stoimenova
authors.affiliation: Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, Aurora, Colorado.
authors.forename: Kevin
authors.initials: K
authors.lastname: Krughoff
authors.affiliation: Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, Aurora, Colorado.
authors.forename: Khadijah
authors.initials: K
authors.lastname: Eid
authors.affiliation: Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, Aurora, Colorado.
authors.forename: Colin
authors.initials: C
authors.lastname: O'Donnell
authors.affiliation: Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, Aurora, Colorado.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Phillips
authors.affiliation: Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, Aurora, Colorado.
authors.forename: E David
authors.initials: ED
authors.lastname: Crawford
mesh_terms: D017679:Cryotherapy / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*
keywords: biopsy; cryotherapy; prostate; prostatic neoplasms; quality of life