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Photodynamic therapy for prostate cancer—a review of current status and future promise

Nature Clinical Practice Urology volume 6, pages 18–30 (2009)Cite this article

Abstract

Debate is ongoing about the treatment of organ-confined prostate cancer, particularly in men who have low-risk disease detected by PSA screening. A balance is needed between the harms and benefits of treatment. New techniques are being developed that aim to offer similar treatment effects to current radical therapies, while reducing the associated harmful effects of these treatments. In this Review, we explore the potential of one such technique, photodynamic therapy (PDT), for the treatment of organ-confined prostate cancer. PDT uses a photosensitizing drug that is activated in the prostate by low-power laser light, delivered using optical fibers. The fibers are placed within needles in the prostate, guided by transrectal ultrasound and a perineal template. Following the activation of the photosensitizer by light, and the formation of reactive oxygen species, necrosis occurs at the site of interaction between the photosensitizer, light and oxygen. Clinical studies are underway to investigate the use of PDT for primary and salvage treatment of organ-confined prostate cancer. We review these studies, the potential strategies for enhanced photodynamic effects, and the current limitations of PDT for prostate cancer.

Key Points

  • Photodynamic therapy is under investigation for the treatment of organ-confined prostate cancer

  • Photodynamic therapy involves the activation of a photosensitizing drug, by light of a specific wavelength, in the presence of oxygen to produce reactive oxygen species, which are responsible for localized tissue destruction

  • Improvements in photosensitizer design and light delivery have resulted in consistently better outcomes

  • Much potential exists for further improvements in photosensitizer design, light delivery and treatment monitoring, which could improve the clinical outcomes in men with previously untreated prostate cancer, or those with recurrence after radiotherapy

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Figure 1: The mechanism of action on tumors in photodynamic therapy.
Figure 2: Photodynamic therapy procedure for prostate cancer.

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Acknowledgements

Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. CM Moore is a Clinical Lecturer in Urology at the National Medical Laser Centre and Division of Surgical and Interventional Sciences, D Pendse is an Academic Clinical Fellow at the Department of Imaging, at the Division of Surgical and Interventional Sciences, University College London, University College London Hospitals Trust, and M Emberton is Reader in Interventional Oncology, University College London, London, UK.,

    Caroline M Moore, Doug Pendse & Mark Emberton

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Correspondence to Caroline M Moore.

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Competing interests

Caroline M Moore, Doug Pendse and Mark Emberton have declared that they are each involved in ongoing clinical studies to evaluate the use of palladium bacteropheophorbide vascular-targeted photodynamic therapy (WST-09, WST-11) as a first-line treatment in men with organ-confined prostate cancer. They have all acted as Consultants for Steba Biotech and have received honoraria for this work. The clinical studies are supported by Steba Biotech.

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Moore, C., Pendse, D. & Emberton, M. Photodynamic therapy for prostate cancer—a review of current status and future promise. Nat Rev Urol 6, 18–30 (2009). https://doi.org/10.1038/ncpuro1274

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