The use of novel diagnostic and treatment modalities in the case of primary localized prostate cancer

Nowadays focal therapy of prostate cancer (PCa) is topicality. Advances in the diagnosis of PCa provide the use of novel treatment modalities. Cryoablation, high intensity focused ultrasound (HIFU) and thermal ablation are being reviewed as suitable options for treatment of localized PCa. Even more, HIFU has already proven its role as definitive treatment option in selected cases of PCa, avoiding complications affecting quality of life that could otherwise occur with surgery. Case report presents a 69 years old previously healthy, sexually active male patient with an intermediate risk PCa who received primary treatment with HIFU in April 2019. The first biopsy at PSA level 6,31 ng/ml as well as second biopsy due to increase in PSA level was negative. PSA kept rising and at PSA level 13,54 ng/ml mpMRI was done revealing PCa in the ventral part followed by transperineal MRI – TRUS fusion guided biopsy. Unilateral PCa located in transition zone (Gleason 3+3) was diagnosed. Patient received prostate gland hemi-ablation with HIFU. PSA nadir reached 2,41 ng/ml 5 months after treatment. On follow-up biopsy after 12 months no signs of malignancy were detected. No major complications after treatment were recorded. Focal therapy with HIFU can provide reasonable functional and oncological outcomes in selected group of PCa patients as demonstrated by this clinical case. The role of prostate gland MRI and HIFU in case of primary localized PCa has increased, however, additional studies on treatment and follow-up protocols are required.