1. Alternative Treatments for Localized Prostate Cancer
Dr. Ronald Sorensen

2. Overview
Currently, the options for localized prostate cancer often straddle two ends of a spectrum with active surveillance at one end and radical therapy, such as prostatectomy or radiotherapy at the other
Tissue preserving strategies aim to target the cancer and not the whole organ when it is morphometrically possible to do so and thus limit damage to collateral tissue

3. Overview
Men can expect the following rates of toxicity from radical therapy on average:
Erectile dysfunction: 30-90%
Incontinence: 5-20%
Rectal toxicity: 5-20%

4. Patient Selection
Appropriate selection is key when considering alternative treatment modalities:
Pts who cannot tolerate radical treatments
Pts who have a short life expectancy
Pts with low risk disease who do not wish to undergo conservative management

5. Ablative Technology
Cryotherapy: ablation of tissue by extremely cold temperatures

6. Ablative Technology
High Intensity Focused Ultrasound (HIFU): mechanical vibrations above the threshold of human hearing (16 kHz) which have the ability to interact with tissue to produce biological changes

7. Ablative Technology
Photodynamic therapy: uses a photosensitizing drug that is active, after a given drug-light interval, by light of a specific wavelength. It requires tissue oxygen for the treatment effect with the active drug forming reactive oxygen species, which are directly responsible for damage to the treated volume

8. Ablative Technology
Focal Irreversible Electroporation: causes tissue damage by permanently altering the cell homeostasis using low-energy current leading to cell death.

9. Radiofrequency Ablation (RFA)
RFA: converts radiofrequency waves to heat, resulting in thermal damage. High-frequency current flows from the needle electrode to target tissue with resultant ionic agitation and heat producing molecular friction, denaturation of proteins, and cell membrane disintegration.

10. Outcomes
Most of these treatments are experimental and thus high-quality long term outcome data is lacking
Outcomes must be considered in light of patient goals-of-care