Focal Therapy in Primary Localised Prostate Cancer: The European Association of Urology Position in 2018

Radical treatment of localised prostate cancer is recognised to be an unnecessary intervention or overtreatment in many men. Consequently, there has been a rapid uptake in the use of focal ablative therapies.

However, there are several biological and practical concerns about such approaches as they have yet to be proved as robust treatment options. In particular, the multifocal nature of prostate cancer argues against unifocal treatment, while limitations in imaging can preclude the accurate identification of the number, location, and extent of prostate cancer foci. To date, a number of ablative options have reported results on mainly low-risk disease. Most series are relatively immature, with a lack of consistent follow-up, and the morbidity of retreatment is often not considered. The authors consider focal therapy to be an investigational modality, and encourage prospective recording of outcomes and recruitment of suitable patients.

Focal therapy of prostate cancer is the targeted destruction of cancer within a specific part of the prostate gland, sparing the rest of the prostate and nearby tissue. This procedure could potentially reduce side effects when compared with established standard treatments, such as surgery or radiotherapy, which treat the entire prostate. Studies show that for most men with low-risk cancer, active surveillance is the preferred treatment option. However, the available data regarding all forms of focal therapy are still poor and inconclusive. Consequently, due to both the lack of clear results associated with focal therapy and the difficulties in detecting all cancerous areas of the prostate, focal therapy should be considered an investigational modality only.

European urology. 2018 Jan 17 [Epub ahead of print]

Henk G van der Poel, Roderick C N van den Bergh, Erik Briers, Philip Cornford, Alex Govorov, Ann M Henry, Thomas B Lam, Malcolm D Mason, Olivier Rouvière, Maria De Santis, Peter-Paul M Willemse, Hendrik van Poppel, Nicolas Mottet

Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: ., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Patients Advocate, Hasselt, Belgium., Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK., Department of Urology, Moscow State University of Medicine and Dentistry, Moscow, Russia., Leeds Cancer Centre, St. James's University Hospital, Leeds, UK., Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK., Division of Cancer & Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK., Hospices Civils de Lyon, Radiology Department, Edouard Herriot Hospital, Lyon, France., Clinical Trials Unit, University of Warwick, UK; Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, University Utrecht, Utrecht, The Netherlands., Department of Urology, University Hospital K.U. Leuven, Leuven, Belgium., Department of Urology, University Hospital, St. Etienne, France.