Focal Therapy of Prostate Cancer
Focal therapy offers a targeted, minimally invasive, and function-preserving approach to treating prostate cancer. Focal therapy can also potentially extend the pool of active surveillance candidates in situations where clinically significant cancer foci are focally targeted and eradicated, and residual clinically insignificant cancer can be monitored. Due to constant evolution in technology, there are an expanding number of ablative energy sources (cryotherapy, high-intensity focused ultrasound, irreversible electroporation, laser, vascular-targeted photodynamic therapy, brachytherapy, etc.) and multiple guidance systems (ultrasound, multiparametric MRI–ultrasound fusion, or in-bore MRI) available. Selection of technique depends on lesion location, operator expertise, and equipment availability. Despite this, patient selection and meticulous posttreatment monitoring are the cornerstones of a successful focal therapy strategy. Accurate multiparametric MRI interpretation and effective targeted biopsy to identify offending foci and subsequent image-guided therapy require a multidisciplinary of prostate cancer specialists. Although short-term data regarding focal therapy are promising, until long-term outcomes become available, this approach remains under investigation, and urologists should not hesitate to “convert” a patient to whole-gland treatment if the need arises.
