Patients with prostate cancer now face a dizzying array of treatment options, from expectant management to radical prostatectomy. In between these two polarities are a number of focal therapies, including transrectal high-intensity focused ultrasound (HIFU). These are designed to ablate either the whole gland or just the diseased portions. Some have likened the latter approach to the evolution in breast cancer treatment from radical mastectomy to lumpectomy. HIFU is actively used in Europe, Japan, Canada and elsewhere for both the primary and salvage treatment of localized prostate cancer but remains unapproved in the US. The success of any focal therapy depends heavily on locating the cancer with imaging. Although magnetic resonance imaging (MRI) may be the answer for some, others are looking at other approaches to pinpoint tumours, particularly smaller ones.
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