ERAS 2025: ERAS® Beyond Cystectomy Standardizing Pathways on Focal Therapy for Prostate Cancer: How Can We Manage and Reduce Complications?
Despite promising outcomes, the field urgently needs standardization. Focal therapy is not a single procedure but a complex chain, from diagnosis to follow-up. Weakness at any link risks undermining outcomes. MRI quality is highly variable: up to 80% of scans outside referral centers are suboptimal. Radiologist expertise is equally inconsistent, with prostate MRI often interpreted by those lacking adequate case exposure. Similarly, biopsy accuracy, pathology review, and patient selection are critical steps requiring specialized skill. Without consistent quality assurance across these stages, focal therapy outcomes become unreliable.
Prevention of complications also requires systematic planning. Key variables include the choice of energy modality, treatment template, disease location, and patient context. Centers should ideally offer multiple technologies—transperineal approaches for anterior tumors, transrectal or posterior-based energies for posterior lesions—tailored to anatomy. Extent of ablation is another balance: larger fields may reduce recurrence but increase functional morbidity, while ultra-focal treatments risk undertreatment. Standardized protocols must guide this balance.
Ultimately, focal therapy must be managed as a process rather than an isolated act. Multidisciplinary collaboration among radiologists, pathologists, and urologists, combined with structured pathways and quality benchmarks, is essential to secure oncologic safety, minimize complications, and deliver consistent, reproducible outcomes for men with prostate cancer.
Presented by: Giancarlo Marra, MD, Assistant Professor, University of Turin, Turin, Italy
Written by: Stephen B. Williams, MD, MBA, MS, FACS, FACHE @SWilliams_MD on Twitter during the 11th Enhanced Recovery After Surgery (ERAS®) World Congress, September 17-19, 2025, Turin, Italy