To review the current evidence regarding protocols and outcomes of image-guided focal therapy (FT) for prostate cancer (PCa).
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.
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.
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.
World journal of urology. 2020 May 22 [Epub ahead of print]
Rafael R Tourinho-Barbosa, Bradford J Wood, Andre Luis Abreu, Bruno Nahar, Toshitaka Shin, Selcuk Guven, Thomas J Polascik
Department of Urology, Hospital CardioPulmonar, 157, Ponciano Oliveira Street, Salvador, Bahia, 40170-530, Brazil. ., Center for Interventional Oncology, National Cancer Institute, Interventional Radiology, Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, MD, USA., USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA., Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA., Department of Urology, Oita University Faculty of Medicine, Oita, Japan., Department of Urology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey., Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA.