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World Journal of Urology

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01.10.2008 | Topic Paper

Active surveillance and radical therapy in prostate cancer: can focal therapy offer the middle way?

verfasst von: Hashim Uddin Ahmed, Mark Emberton

Erschienen in: World Journal of Urology | Ausgabe 5/2008

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Abstract

Introduction

Focal therapy for prostate cancer is a radical paradigm shift in the management of men with localised prostate cancer. It involves locating and destroying only the areas of prostate cancer whilst leaving the majority of the prostate untreated. By doing so, it is proposed that side-effects of traditional whole-gland therapies such as impotence, incontinence and rectal toxicity will be significantly reduced and cancer control will be at similar levels.

Methods and materials

A Medline/Pubmed search was conducted between 1 May 1998 and 1 May 2008 using the following terms: 'focal therapy', 'lumpectomy', 'hemiablation', 'laterality', 'multifocal', 'unifocal' and 'index lesion' alongside 'prostate cancer'. Articles were selected for their relevance to this review. Abstracts from international conferences over the last 5 years were also used where appropriate. Authors' personal bibliography was used to supplement the review.

Conclusions

A number of case series have reported significantly lower incontinence and impotence rates using focal cryoablation and one series on focal HIFU. The reporting quality has been variable and there are currently ongoing clinical trials with IRB approval in the USA and UK. Long term follow-up is required. Focal therapy is an exciting new area of research that could hold great promise for men with localised low to intermediate risk prostate cancer.

Cancer Research UK Cancer Statistics (UK). www.cancer.org.uk

Wise AM, Stamey TA, McNeal JE, Clayton JL (2002) Morphologic and clinical significance of multiple prostate cancer in radical prostatectomy specimens. Urology 60:264–269PubMedCrossRef

Galper SL, Chen MH, Catalona WJ, Roehl KA, Richie JP, D’Amico AV (2006) Evidence to support a continued stage migration and decrease in prostate cancer specific mortality. J Urol 175(3 Pt 1):907–912PubMedCrossRef

Cooperberg MR, Moul JW, Carroll PR (2005) The changing face of prostate cancer. J Clin Onc 23(32):8146–8151

Mazur DJ, Merz JF (1996) How older patients’ treatment preferences are influenced by disclosures about therapeutic uncertainty: surgery versus expectant management for localized prostate cancer. J Am Geriatr Soc 44:934–937PubMed

Crawford ED, Bennett CL, Stone NN et al (1997) Comparison of perspectives on prostate cancer: analyses of survey data. Urology 50:366–372PubMedCrossRef

Singer PA, Tasch ES, Stocking C, Rubin S, Siegler M, Weichselbaum R (1991) Sex or survival: trade-offs between quality and quantity of life. J Clin Oncol 9:328–334PubMed

Bill-Axelsen A, Holmberg L, Ruuth Mirrja et al (2005) Watchful waiting and prostate cancer. NEJM 352:1977–1984CrossRef

Merrill RM, Stephenson RA (2000) Trends in mortality rates in patients with prostate cancer during the era of prostate specific screening. J Urol 163:503–510PubMedCrossRef

10.

Potosky AL, Davis WW, Hoffman RM, Stanford JL, Stephenson RA, Penson DF, Harlan LC (2004) Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: the prostate cancer outcomes study. J Natl Cancer Inst 96(18):1358–1367PubMed

11.

Penson DF, Litwin MS (2003) The physical burden of prostate cancer. Urol Clin North Am 30(2):305–313PubMedCrossRef

12.

Klotz L (2006) Active surveillance with selective delayed intervention for favorable risk prostate cancer. Urol Oncol 24(1):46–50PubMed

13.

Hardie C, Parker C, Norman A, Eeles R, Horwich A, Huddart R, Dearnaley D (2005) Early outcomes of active surveillance for localized prostate cancer. BJU Int 95(7):956–960PubMedCrossRef

14.

O’Leary MP (2003) Lower urinary tract symptoms/benign prostatic hyperplasia: maintaining symptom control and reducing complications. Urology 62(3 Suppl 1):15–23PubMedCrossRef

15.

Watson V, Ryan M, Brown CT, Barnett G, Ellis BW, Emberton M (2004) Eliciting preferences for drug treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia. J Urol 172(6 Pt 1):2321–2325PubMedCrossRef

16.

Ahmed HU, Pendse D, Illing R, Allen C, van der Meulen JH, Emberton M (2007) Will focal therapy become a standard of care for men with localized prostate cancer? Nat Clin Pract Oncol. 4(11):632–642PubMedCrossRef

17.

Eggener SE, Scardino PT, Carroll PR, Zelefsky MJ, Sartor O, Hricak H, Wheeler TM, Fine SW, Trachtenberg J, Rubin MA, Ohori M, Kuroiwa K, Rossignol M, Abenhaim L; International Task Force on Prostate Cancer and the Focal Lesion Paradigm (2007) Focal therapy for localized prostate cancer: a critical appraisal of rationale and modalities. J Urol 178(6):2260–2267

18.

Djavan B, Susani M, Bursa B et al (2000) Predictability and significance of multi-focal prostate cancer in the radical prostatectomy specimen. Tech Urol 5:139–142

19.

Quintal MM, Magna LA, Guimaraes MS, Ruano T, Ferreira U, Billis A (2006) Prostate cancer pathologic stage pT2b (2002 TNM staging system): does it exist? Int Braz J Urol 32(1):43–47PubMedCrossRef

20.

Langenstroer P, Carroll P, Thrasher JB (2005) Clinical and pathological characteristics of unstageable prostate cancer: analysis of the CaPSURE database. J Urol 174(1):118–120PubMedCrossRef

21.

Gregori A, Vieweg J, Dahm P, Paulson DF (2001) Comparison of ultrasound-guided biopsies and prostatectomy specimens: predictive accuracy of Gleason score and tumor site. Urol Int 66:66–71PubMedCrossRef

22.

Ramos CG, Carvalhal GF, Smith DS, Mager DE, Catalona WJ (1999) Clinical and pathological characteristics, and recurrence rates of stage T1c versus T2a or T2b prostate cancer. J Urol 161(5):1525–1529PubMedCrossRef

23.

Scales CD Jr, Presti JC Jr, Kane CJ, Terris MK, Aronson WJ, Amling CL, Freedland SJ, SEARCH Database Study Group (2007) Predicting unilateral prostate cancer based on biopsy features: implications for focal ablative therapy–results from the SEARCH database. J Urol 178(4 Pt 1):1249–1252PubMedCrossRef

24.

Mouraviev V, Mayes JM, Sun L, Madden JF, Moul JW, Polascik TJ (2007) Prostate cancer laterality as a rationale of focal ablative therapy for the treatment of clinically localized prostate cancer. Cancer 110(4):906–910PubMedCrossRef

25.

Mouraviev V, Mayes JM, Madden JF, Sun L, Polascik TJ (2007) Analysis of laterality and percentage of tumor involvement in 1386 prostatectomized specimens for selection of unilateral focal cryotherapy. Technol Cancer Res Treat 6(2):91–95PubMed

26.

Chen ME, Johnston DA, Tang K, Babaian RJ, Troncosco P (2000) Detailed mapping of prostate carcinoma foci: biopsy strategy implications. Cancer 89(8):1800–1809PubMedCrossRef

27.

Miller GJ, Cygan JM (1994) Morphology of prostate cancer: the effects of multifocality on histological grade, tumor volume and capsule penetration. J Urol 152(5 Pt 2):1709–1713PubMed

28.

Simma-Chiang V, Hom JJ, Simko JP, Chan JM, Carroll PR (2006) Increased prevalence of unifocal prostate cancer in a contemporary series of radical prostatectomy specimens: implications for focal ablation. AUA Annual Meeting, Atlanta 2006; Abstract 1163

29.

Ohori M, Eastham JA, Koh H, Kuroiwa K, Slawin KM, Wheeler, TM, Scardino PT. Is focal therapy reasonable in patients with early stage prostate cancer (CAP)—an analysis of radical prostatectomy (RP) specimens. AUA Annual Meeting, Atlanta 2006; Abstract 1574

30.

Furuno T, Demura T, Kaneta T, Gotoda H, Muraoka S, Sato T, Nagamori S, Shinohara N, Koyanagi T (2004) Difference of cancer core distribution between first and repeat biopsy: In patients diagnosed by extensive transperineal ultrasound guided template prostate biopsy. Prostate 58(1):76–81PubMedCrossRef

31.

Villers A, McNeal JE, Freiha FS et al (1992) Multiple cancers in the prostate: morphologic features of clinically recognized vs. incidental tumors. Cancer 70:2312–2318CrossRef

32.

Stamey TA, Freiha FS, McNeal JE, Redwine EA, Whittemore AS, Schmid HP (1993) Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer. Cancer 71(Suppl 3):933–938PubMedCrossRef

33.

Truskinovsky AM, Sanderson H, Epstein JI (2004) Characterization of minute adenocarcinomas of prostate at radical prostatectomy. Urology 64(4):733–737PubMedCrossRef

34.

Nelson BA, Shappell SB, Chang SS, Wells N, Farnham SB, Smith JA Jr, Cookson MS (2006) Tumour volume is an independent predictor of prostate-specific antigen recurrence in patients undergoing radical prostatectomy for clinically localized prostate cancer. BJU Int 97(6):1169–1172PubMedCrossRef

35.

Kikuchi E, Scardino PT, Wheeler TM, Slawin KM, Ohori M (2004) Is tumor volume an independent prognostic factor in clinically localized prostate cancer? J Urol 172(2):508–511PubMedCrossRef

36.

Hanson JA, Gillespie JW, Grover A, Tangrea MA, Chuaqui RF et al (2006) Gene promoter methylation in prostate tumor-associated stromal cells. J Natl Cancer Inst 98(4):255–261PubMed

37.

Uetsuki H, Tsunemori H, Taoka R, Haba R, Ishikawa M, Kakehi Y (2005) Expression of a novel biomarker, EPCA, in adenocarcinomas and precancerous lesions in the prostate. J Urol 174(2):514–518PubMedCrossRef

38.

Chandran UR, Dhir R, Ma C, Michalopoulos G, Becich M, Gilbertson J (2005) Differences in gene expression in prostate cancer, normal appearing prostate tissue adjacent to cancer and prostate tissue from cancer free organ donors. BMC Cancer 5(1):45PubMedCrossRef

39.

Crawford ED, Wilson SS, Torkko KC, Hirano D, Stewart JS, Brammell C, Wilson RS, Kawata N, Sullivan H, Lucia MS, Werahera PN (2005) Clinical staging of prostate cancer: a computer-simulated study of transperineal prostate biopsy. BJU Int 96(7):999–1004PubMedCrossRef

40.

Richie JP (2005) Radical prostatectomy vs watchful waiting in early prostate cancer. BJU Int 96:951–952PubMedCrossRef

41.

Loeb S, Gonzalez CM, Roehl KA, Han M, Antenor JA, Yap RL, Catalona WJ (2006) Pathological characteristics of prostate cancer detected through prostate specific antigen based screening. J Urol 175(3 Pt 1):902–906PubMedCrossRef

42.

Konety BR, Bird VY, Deorah S, Dahmoush L (2005) Comparison of the incidence of latent prostate cancer detected at autopsy before and after the prostate specific antigen era. J Urol 174(5):1785–1788PubMedCrossRef

43.

Draisma G, Boer R, Otto SJ et al (2003) Lead times and over detection due to prostate-specific antigen screening: estimates from the European randomized study of screening for prostate cancer. J Natl Cancer Inst 95:868–878PubMedCrossRef

44.

Nicholson PW, Harland SJ (2002) Survival prospects after screen-detection of prostate cancer. BJU Int 90:686–693PubMedCrossRef

45.

Klotz L (2004) Active surveillance with selective delayed intervention: using natural history to guide treatment in good risk prostate cancer. J Urol 172:S48–S50PubMedCrossRef

46.

Nilsson S, Norlen BJ, Widmark A (2004) A systematic overview of radiation therapy effects in prostate cancer. Acta Oncol 43(4):316–381PubMedCrossRef

47.

Meraney AM, Haese A, Palisaar J, Graefen M, Steuber T, Huland H, Klein EA (2005) Surgical management of prostate cancer: advances based on a rational approach to the data. Eur J Cancer 41(6):888–907PubMedCrossRef

48.

Hegarty NJ, Kaouk JH (2006) Radical prostatectomy: a comparison of open, laparoscopic and robot-assisted laparoscopic techniques. Can J Urol 13 Suppl 1:56–61PubMed

49.

Khoo VS (2005) Radiotherapeutic techniques for prostate cancer, dose escalation and brachytherapy. Clin Oncol (R Coll Radiol) 17(7):560–571

50.

Klotz L (2005) Active surveillance for prostate cancer: for whom? J Clin Oncol 23(32):8165–8169PubMedCrossRef

51.

Freedland SJ, Aronson WJ, Terris MK, Kane CJ, Amling CL, Dorey F, Presti JC Jr, The SEARCH Database Study Group (2003) Percent of prostate needle biopsy cores with cancer is significant independent predictor of prostate specific antigen recurrence following radical prostatectomy: results from SEARCH database. J Urol 169(6):2136–2141PubMedCrossRef

52.

Amin M, Boccon-Gibod L, Egevad L et al (2005) Prognostic and predictive factors and reporting of prostate carcinoma in prostate needle biopsy specimens. Scand J Urol Nephrol Suppl 216:20–33PubMedCrossRef

53.

Antunes AA, Srougi M, Dall’Oglio MF, Crippa A, Campagnari JC, Leite KR (2005) The percentage of positive biopsy cores as a predictor of disease recurrence in patients with prostate cancer treated with radical prostatectomy. BJU Int 96(9):1258–1263PubMedCrossRef

54.

Zhou P, Chen MH, McLeod D, Carroll PR, Moul JW, D’Amico AV (2005) Predictors of prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Clin Oncol 23(28):6992–6998PubMedCrossRef

55.

Albertsen PC, Hanley JA, Fine J (2005) 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA 293(17):2095–2101PubMedCrossRef

56.

Hardie C, Parker C, Norman A, Eeles R, Horwich A, Huddart R, Dearnaley D (2005) Early outcomes of active surveillance for localized prostate cancer. BJU Int 95(7):956–960PubMedCrossRef

57.

Van As NJ, Norman AR, Woode-Amissah R, Horwich A, Dearnaley DP, Huddart RA, Khoo V, Thompson A, Parker CC (2007) Active surveillance of low risk localized prostate cancer: baseline predictors of disease progression. Prostate Cancer Symposium, ASCO 2007, Orlando, FL

58.

Klotz LH, Nam RK (2006) Active surveillance with selective delayed intervention for favourable risk prostate cancer: clinical experience and a ‘number needed to treat’ analysis. Can J Urol 13 Suppl 1:48–55PubMed

59.

Johansson JE, Andren O, Andersson SO, Dickman PW, Holmberg L, Magnusson A, Adami HO (2004) Natural history of early, localized prostate cancer. JAMA 291(22):2713–2719

60.

Chatterjee SK, Zetter BR (2005) Cancer biomarkers: knowing the present and predicting the future. Future Oncol 1(1):37–50PubMedCrossRef

61.

Zeliadt SB, Ramsey SD, Penson DF, Hall IJ, Ekwueme DU, Stroud L, Lee JW (2006) Why do men choose one treatment over another?: a review of patient decision making for localized prostate cancer. Cancer 106(9):1865–1874PubMedCrossRef

62.

Burnet KL, Parker C, Dearnaley D, Brewin CR, Watson M (2007) Does active surveillance for men with localized prostate cancer carry psychological morbidity? BJU Int 100(3):540–543PubMedCrossRef

63.

Dale W, Bilir P, Han M, Meltzer D (2005) The role of anxiety in prostate carcinoma: a structured review of the literature. Cancer 104(3):467–478PubMedCrossRef

64.

Pickles T, Ruether JD, Weir L, Carlson L, Jakulj F, SCRN Communication Team (2007) Psychosocial barriers to active surveillance for the management of early prostate cancer and a strategy for increased acceptance. BJU Int 100:544–551PubMedCrossRef

65.

Latini DM, Hart SL, Knight SJ, Cowan JE, Ross PL, Duchane J, Carroll PR, CaPSURE Investigators (2007) The relationship between anxiety and time to treatment for patients with prostate cancer on surveillance. J Urol 178(3 Pt 1):826–831PubMedCrossRef

66.

Heenan SD (2004) Magnetic resonance imaging in prostate cancer. Prostate Cancer Prostatic Dis 7(4):282–288PubMedCrossRef

67.

Hricak H (2005) MR imaging and MR spectroscopic imaging in the pre-treatment evaluation of prostate cancer. Br J Radiol 78(2):S103–S111PubMedCrossRef

68.

Kirkham AP, Emberton M, Allen C (2006) How Good Is MRI at Detecting and Characterising Cancer within the Prostate? Eur Urol 50(6):1163–1174PubMedCrossRef

69.

Tanimoto A, Nakashima J, Shinmoto H, Okuda S, Kuribayas S (2004) Prostate cancer screening: the clinical value of diffusion-weighting imaging and dynamic MR imaging. Proc Intl Soc Mag Reson Med 14:3323

70.

Mazahari Y, Koutcher JA, Shukla-Dave A, Hricak H (2006) Imaging and multi-parametric analysis of cancerous tissue (IMPACT): Prostate Cancer (PCa). Proc Intl Soc Mag Reson Med 14:3497

71.

Kim CK, Park BK, Kim B (2006) Localization of prostate cancer using 3T MRI: comparison of T2-weighted and dynamic contrast-enhanced imaging. J Comput Assist Tomogr 30(1):7–11PubMedCrossRef

72.

73.

Furuno T, Demura T, Kaneta T, Gotoda H, Muraoka S et al (2004) Difference of cancer core distribution between first and repeat biopsy: in patients diagnosed by extensive transperineal ultrasound guided template prostate biopsy. Prostate 58:76–81PubMedCrossRef

74.

Barzell WE, Melamed MR (2007) Appropriate patient selection in the focal treatment of prostate cancer: the role of transperineal 3-dimensional pathologic mapping of the prostate–a 4-year experience. Urology 70(6 Suppl):27–35PubMedCrossRef

75.

Satoh T, Matsumoto K, Fujita T, Tabata K, Okusa H, Tsuboi T, Arakawa T, Irie A, Egawa S, Baba S (2005) Cancer core distribution in patients diagnosed by extended transperineal prostate biopsy. Urology 66(1):114–118PubMedCrossRef

76.

Onik G, Barzell W (2007) 3D prostate mapping biopsy: an essential procedure for patients considering “watchful waiting” for prostate cancer. SIR 2007

77.

Ahmed HU, Stevens D, Barbouti O, Zacharakis E, Illing RO, Pendse D, Allen C, Freeman A, Emberton M (2008) Prostate cancer risk stratification and cancer mapping—template transperineal prostate mapping biopsies. EAU 2008

78.

Lagerburg V, Moerland MA, Lagendijk JJ, Battermann JJ (2005) Measurement of prostate rotation during insertion of needles for brachytherapy. Radiother Oncol 77(3):318–323PubMedCrossRef

79.

Miller J, Perumalla C, Heap G (2005) Complications of transrectal versus transperineal prostate biopsy. ANZ J Surg 75(1–2):48–50PubMedCrossRef

80.

Pinkstaff DM, Igel TC, Petrou SP, Broden GA, Wehle MJ, Young PR (2005) Systematic transperineal ultrasound-guided template biopsy of the prostate: three-year experience. Urology 65(4):735–739PubMedCrossRef

81.

Andriole GL. Biopsy: is there a better way to biopsy the prostate? In course: where we’ve been and where we’re going: current issues in localized prostate cancer. AUA Annual Meeting, 2006, Atlanta

82.

Barqawi A, Crawford ED (2005) Focal therapy in prostate cancer: future trends. BJU Int 95:273–280PubMedCrossRef

83.

Onik G (2001) Image-guided prostate cryosurgery: state of the art. Cancer Control 8(6):522–531PubMed

84.

Merrick GS, Wallner KE, Butler WM (2005) Prostate cryotherapy: more questions than answers. Urology 66:9–15PubMedCrossRef

85.

Uchida T, Ohkusa H, Nagata Y, Hyodo T, Satoh T, Irie A (2006) Treatment of localized prostate cancer using high-intensity focused ultrasound. BJU Int 97:56–61PubMedCrossRef

86.

Blana A, Walter B, Rogenhofer S, Wieland WF (2004) High-intensity focused ultrasound for the treatment of localised prostate cancer: 5-year experience. Urology 63:297–300PubMedCrossRef

87.

Moore CM, Hoh IM, Bown SG, Emberton M (2005) Does photodynamic therapy have the necessary attributes to become a future treatment for organ-confined prostate cancer? BJU Int 96:754–758PubMedCrossRef

88.

Moore CM, Nathan TR, Lees WR, Mosse CA, Freeman A, Emberton M, Bown SG (2006) Photodynamic therapy using meso tetra hydroxy phenyl chlorin (mTHPC) in early prostate cancer. Lasers Surg Med 38(5):356–363PubMedCrossRef

89.

Mirza AN, Fornage BD, Sneige N, Kuerer HM, Newman LA, Ames FC, Singletary SE (2001) Radiofrequency ablation of solid tumors. Cancer J 7(2):95–102PubMed

90.

Zlotta AR, Djavan B, Matos C et al (1998) Percutaneous transperineal radiofrequency ablation of prostate tumour: safety, feasibility and pathological effects on human prostate cancer. Br J Urol 81(2):265PubMed

91.

Beerlage HP, Thuroff S, Madersbacher S, Zlotta AR, Aus G, de Reijke TM, de la Rosette JJ (2000) Current status of minimally invasive treatment options for localized prostate carcinoma. Eur Urol 37(1):2–13PubMedCrossRef

92.

Illing RO, Leslie TA, Kennedy JE, Calleary JG, Ogden CW, Emberton M (2006) Visually directed HIFU for organ confined prostate cancer—a proposed standard for the conduct of therapy. BJU Int 98(6):1187–1192PubMedCrossRef

93.

Ryu J, Kim B (2001) MR imaging of the male and female urethra. Radiographics 21(5):1169–1185PubMed

94.

Sloboda RS, Pedersen JE (2005) The importance of urethra visualization for preplanned permanent prostate implants. Brachytherapy 4(3):195–201PubMedCrossRef

95.

Jolesz FA, Hynynen K, McDannold N, Tempany C (2005) MR imaging-controlled focused ultrasound ablation: a noninvasive image-guided surgery. Magn Reson Imaging. Clin N Am 13(3):545–560

96.

American Society for Therapeutic Radiology and Oncology Consensus Panel: consensus statement: guidelines for PSA following radiation therapy (1997) In J Radiat 37:1035–1041

97.

Critz FA (2002) A standard definition of disease freedom is needed for prostate cancer: undetectable prostate specific antigen compared with the American Society for Therapeutic Radiology and Oncology consensus definition. J Urol 167:1310–1313PubMedCrossRef

98.

Onik G, Narayan P, Vaughan D, Dineen M, Brunelle R (2002) Focal “nerve-sparing” cryosurgery for treatment of primary prostate cancer: a new approach to preserving potency. Urology 60:109–114PubMedCrossRef

99.

Onik G, Vaughan D, Lotenfoe R, Dineen M, Brady J (2007) “Male lumpectomy”: focal therapy for prostate cancer using cryoablation. Urology 70(6 Suppl):16–21PubMedCrossRef

100.

Ellis DS, Manny TB Jr, Rewcastle JC (2007) Focal cryosurgery followed by penile rehabilitation as primary treatment for localized prostate cancer: initial results. Urology 70(6 Suppl):9–15PubMedCrossRef

101.

Lambert EH, Bolte K, Masson P, Katz AE (2007) Focal cryosurgery: encouraging health outcomes for unifocal prostate cancer. Urology 69(6):1117–1120PubMedCrossRef

102.

Muto S, Yoshii T, Saito K, Kamiyama Y, Ide H, Horie S (2008) Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. Jpn J Clin Oncol 38(3):192–199PubMedCrossRef

Titel: Active surveillance and radical therapy in prostate cancer: can focal therapy offer the middle way?
verfasst von: Hashim Uddin Ahmed
Mark Emberton
Publikationsdatum: 01.10.2008
Verlag: Springer-Verlag
Erschienen in: World Journal of Urology / Ausgabe 5/2008
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-008-0317-5

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Springer Medizin

Active surveillance and radical therapy in prostate cancer: can focal therapy offer the middle way?

Abstract

Introduction

Methods and materials

Conclusions

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Methods and materials

Conclusions

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