INTERSTITIAL PDT AND VTP
FOR PROSTATE CANCER
For men with low-risk localised prostate cancer seeking an alternative to active surveillance or radical treatment, vascular-targeted PDT (VTP) with TOOKAD provides an EMA-approved focal therapy option β destroying tumour while preserving continence and sexual function.
analyticsAt a Glance
- check_circleEMA-approved (TOOKAD/padeliporfin) for low-risk localised prostate cancer
- check_circlePCM301 Phase III trial: 49% complete response vs 13.5% active surveillance at 24 weeks
- check_circleTransperineal needle delivery β no endoscopy, no surgery; under general anaesthesia day case
- check_circleUrinary continence preserved in >95% of patients; erectile function preservation superior to surgery/radiation
Why Prostate Cancer Needs a Different PDT Approach
The prostate is a deeply seated solid organ β inaccessible to the surface-applied or endoscopically delivered light that works for oesophageal, lung, or skin PDT. Treating the prostate required an entirely different delivery strategy: interstitial light delivery via needles passed through the perineum.
βProstate PDT flipped the traditional PDT approach. Instead of shining light onto a surface from outside, light is delivered from within the prostate gland through multiple transperineal needles β a technically elegant solution to the deep tissue access problem.β
Interstitial Light Delivery: The Core Innovation
Multiple thin optical fibres are inserted transperineally (through the perineum, guided by transrectal ultrasound) to position fibre tips throughout the prostate gland. Light is then delivered simultaneously from all fibres β creating overlapping zones of photochemical activation that cover the entire prostate or the targeted focal area. This approach allows treatment of any deep solid organ accessible by needle insertion.
Vascular-Targeted PDT: The WST11 Mechanism
WST11 (padeliporfin, marketed as TOOKAD Soluble) is the photosensitiser used in prostate VTP. It works differently from Photofrin: rather than accumulating in tumour cells, WST11 stays in the blood vessels and is activated in the vasculature by the light delivered through the prostate. This vascular occlusion β destroying tumour blood supply β achieves tumour necrosis through ischaemia rather than direct cell photodamage.
PCM301 Phase III Trial: The Pivotal Evidence
The PCM301 trial (Azzouzi et al., Lancet Oncology 2017) is the landmark randomised controlled trial that led to EMA approval of TOOKAD for low-risk prostate cancer.
PCM301 β VTP vs Active Surveillance at 24 Weeks
413 patients with low-risk prostate cancer (Gleason β€6, PSA β€10, cT1βT2a). Primary endpoint: complete response (all biopsies negative) at 24 weeks.
- Complete Response β VTP Arm49%
- Complete Response β Active Surveillance13.5%
- Progression to Radical Treatment (VTP)6%
- Progression to Radical Treatment (Surveillance)29%
Functional Outcomes β VTP vs Active Surveillance
Functional outcomes at 24 months β demonstrating preservation of quality-of-life endpoints.
- Urinary Continence Preserved>95%
- Erectile Function Preserved at 24 Months~80%
- Serious Adverse Events5%
The VTP Procedure: What Patients Experience
Prostate VTP is performed under general anaesthesia and completed as a day case or with one overnight stay β substantially less invasive than radical prostatectomy.
Patient Preparation
Transrectal ultrasound (TRUS) mapping to confirm tumour location and prostate volume. MRI review. Bowel preparation. General anaesthesia or spinal anaesthesia on the day of procedure.
Transperineal Needle Placement
Under TRUS guidance, 10β20 thin needles are inserted transperineally using a brachytherapy-style template grid. Optical fibres are advanced through the needles to position light delivery points throughout the prostate (whole gland) or in the target focal area. Positioning takes approximately 45β60 minutes.
WST11 Intravenous Infusion
WST11 is infused intravenously over 10 minutes. Lights are turned off in the operating theatre during infusion and light delivery β because WST11 is activated by visible light, ambient light exposure must be minimised during the procedure.
Light Delivery
Red laser (753 nm for WST11 β longer wavelength than Photofrin for deeper penetration) is delivered simultaneously from all fibres for approximately 22 minutes. The light activates WST11 in the prostate vasculature, causing vascular occlusion and tumour ischaemia throughout the illuminated volume.
Recovery
Needles and catheter removed. Most patients are discharged same day or after one overnight stay. A urinary catheter is left in place for 24 hours. Return to normal activity within 1β2 weeks. PSA and prostate MRI at 3β6 months for response assessment.
Patient Selection for Prostate VTP
VTP is specifically for low-risk localised prostate cancer. Patient selection is critical β it is not appropriate for intermediate or high-risk disease.
| Criterion | Suitable for VTP | Not Suitable for VTP |
|---|---|---|
| Gleason Grade / Grade Group | Gleason 6 (Grade Group 1) β low-grade histology | Gleason 7+ (Grade Group 2+) β not suitable for VTP |
| PSA | PSA β€10 ng/mL | PSA >10 ng/mL β higher risk disease |
| Clinical Stage | cT1βT2a (localised to prostate) | T2b or higher; extracapsular extension; nodal disease |
| Treatment Intent | Curative intent for low-risk localised disease; reducing progression risk vs surveillance | Metastatic disease; palliative setting β VTP not appropriate |
| Prior Treatment | Treatment-naΓ―ve; active surveillance patients | Prior prostatectomy or radiation (anatomy altered) |
| Patient Preference | Patient values function preservation; comfortable with monitoring PSA and MRI response | Patient strongly prefers definitive radical treatment with no residual risk |
Explore the PDT Knowledge Base
Related PDT topics and resources.
Frequently Asked Questions
Common questions about prostate cancer PDT.
About the Treatment
Is prostate VTP available in China and India?
TOOKAD/WST11 VTP is currently EMA-approved and primarily available in Europe and Israel (where it was developed at Weizmann Institute). Availability in China and India is limited β neither country yet has NMPA or CDSCO approval for WST11, though selected academic centres in both countries are investigating it. For patients seeking prostate VTP through CancerFax, European centres (particularly in France, the Netherlands, and the UK) and Israeli centres with established programmes are the primary options. This may evolve as Asian regulatory approvals progress.
What happens if my PSA rises again after VTP?
Rising PSA after VTP indicates treatment failure or disease recurrence. Options include: MRI-targeted repeat biopsy to assess disease grade and extent; repeat VTP if the recurrence is again low-grade and focal; transition to definitive radical treatment (prostatectomy or radiation) if disease has progressed to intermediate risk. VTP does not damage the anatomy in a way that precludes subsequent surgery or radiation β this is an important advantage over treatments that cause fibrosis.
How CancerFax Helps
CancerFax is a specialist cancer access and patient-navigation platform. We help patients and families understand their options, organise medical records, coordinate hospital communication, and support cross-border treatment planning where appropriate.
We help collect and organise reports, scans, pathology, biomarker results, and treatment history for structured case review.
We communicate with hospitals or trial teams to assess whether a case may be suitable for further screening.
We support appointment coordination, document submission, translation, and direct communication with international departments.
For international patients, we help with practical coordination β travel planning, hospital admission guidance, and local support.
If this option is not suitable, we help explore other relevant treatments, clinical trials, or advanced care pathways.
From inquiry through to follow-up, our coordinators provide a single point of contact for the family.
CancerFax does not guarantee treatment access, eligibility, or clinical outcome. Our role is to help patients access accurate information, structured review, and appropriate specialist pathways.
Low-Risk Prostate Cancer? Prostate VTP May Be the Right Focal Therapy.
Upload your MRI, biopsy results, and PSA history. Our urologic oncology team will assess whether vascular-targeted PDT is appropriate and identify accredited prostate VTP centres.
For informational purposes only. Prostate cancer treatment decisions require evaluation by qualified urologic oncology specialists. VTP is approved for low-risk localised disease only.