World J Urol. 2021 Mar;39(3):701-717. doi: 10.1007/s00345-020-03254-4. Epub 2020 May 22.

Current state of image-guided focal therapy for prostate cancer.

World journal of urology

Rafael R Tourinho-Barbosa, Bradford J Wood, Andre Luis Abreu, Bruno Nahar, Toshitaka Shin, Selcuk Guven, Thomas J Polascik

PMID: 32444886 DOI: 10.1007/s00345-020-03254-4

Abstract

PURPOSE: To review the current evidence regarding protocols and outcomes of image-guided focal therapy (FT) for prostate cancer (PCa).

METHODS: A literature search of the latest published studies assessing primary FT for PCa was carried out in Medline and Cochrane library databases followed by a critical review. FT modalities, follow-up strategies, and oncological and toxicity outcomes were summarized and discussed in this review.

RESULTS: Twenty-four studies with six different sources of energy met the inclusion criteria. A heterogeneity of patient selection, energy sources, treatment templates, and definitions of failure was found among the studies. While a third of patients may be found to have additional cancer burden over 3-5 years following FT, most patients will remain free of a radical procedure. The vast majority of patients maintain urinary continence and good erectile function after FT. Acute urinary retention is the most common complication, whilst severe complications remain rare.

CONCLUSION: An increasing number of prospective studies with longer follow-up have been recently published. Acceptable cancer control and low treatment toxicity after FT have been consistently reported. Follow-up imaging and routine biopsy must be encouraged post-FT. While there is no reliable PSA threshold to predict failure after FT, reporting post-FT positive biopsies and retreatment rates appear to be standard when assessing treatment efficacy.

Keywords: Ablation techniques; Focal therapy; Localized; Outcome; Prostate cancer

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MeSH terms

• Ablation Techniques / methods*
• Humans
• Male
• Organ Sparing Treatments / methods*
• Prostatic Neoplasms / surgery*

Publication Types

• Journal Article
• Review