Valerio, M; (2016) An evaluation of novel technologies in focal therapy of localised prostate cancer. Doctoral thesis , UCL (University College London).

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Abstract

The current prostate cancer pathway is debated as the harms seem to outweigh the benefits. Prostate cancer is usually diagnosed through 10-12 cores random biopsies of the prostate in men having clinical or biochemical suspicion of localised disease. The biopsy findings combined with PSA value, patients’ life expectancy and preference are used to drive management. Men with no cancer detected are followed with serial PSA measures. Men harbouring what is deemed insignificant disease are initially counselled to undergo expectant management, although many choose to undergo immediate treatment as the diagnostic is mostly unreliable. Men harbouring clinically significant disease are proposed radical options - such as radical prostatectomy and radiation therapy. The limitations are now evident: the accuracy of standard random biopsy is low at around 50%; the toxicity of radical treatments is substantial for many patients, whereas only a minority of men benefit from treatment within their lifespan. In order to rebalance the therapeutic ratio, an imaging-derived pathway based on multiparametric MRI findings has been proposed. This would include targeted sampling and focal therapy of the area of the prostate harbouring clinically significant cancer. This novel paradigm needs the employment of novel medical devices. Targeted biopsy are currently guided by platforms able to perform MR to ultrasound image fusion. Focal therapy is delivered using medical devices employing modern sources of energy. In this thesis, I tested the hypothesis that the adoption of novel technologies in the focal therapy paradigm would enhance the therapeutic ratio in prostate cancer. The plan of the thesis included: i) to determine optimal health technology evaluation for devices acceptance and adoption; ii) to define the target population; iii) to evaluate the outcomes of platforms able to provide MR to ultrasound fusion for targeted biopsy; iv) to assess the value of novel technologies to deliver focal therapy.

Type:	Thesis (Doctoral)
Title:	An evaluation of novel technologies in focal therapy of localised prostate cancer
Event:	University College London
Language:	English
UCL classification:	UCL > Provost and Vice Provost Offices UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
URI:	https://discovery.ucl.ac.uk/id/eprint/1515790

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