Focal therapy (FT) represents a promising strategy for the management of localized prostate cancer (PCa). However, due to limited long-term evidence and the heterogeneity of prostate cancer, its use must be carefully considered, and patient selection must be stringent. A panel of urologists with expertise in PCa and FT was selected by the Italian Society of Urology (SIU - Società Italiana di Urologia) and proposed criteria to consider in FT for PCa, with the aim of supporting its use in clinical practice. The ideal candidate for FT is a patient with a unilateral, localized, multiparametric MRI-visible lesion, harboring intermediate-risk PCa (ISUP Grade Group 2) and a life expectancy greater than 10 years. The different energy sources used in FT (cryotherapy, high-intensity focused ultrasound, irreversible electroporation, and transperineal laser ablation) offer comparable oncological and functional outcomes. The choice of energy modality primarily depends on tumor location, physician expertise, and local availability of the technology. Different FT failure definitions exist. Standard follow-up should always include PSA monitoring and mpMRI. Follow-up biopsy should not be routinely performed in every patient except for centers starting a FT program. Per protocol biopsy should be considered depending on the risk of PCa treated with FT. The SIU position paper on FT aims to guide its use in clinical practice by providing recommendations to select, treat and follow-up patients.
Minerva urology and nephrology. 2026 Feb [Epub]
Giovanni Lughezzani, Antonio Celia, Vittorio Fasulo, Giancarlo Marra, Tommaso Silvestri, Gianni Vittori, Armando Stabile, Riccardo Mastroianni, Alessandro Branchi, Ugo Falagario, Giuseppe Simone, Pierluigi Bove, Valerio Iacovelli, Stefano DE Luca, Vincenzo Ficarra, Andrea Minervini, Andrea Salonia, Vincenzo Mirone, Giuseppe Carrieri, Nicolò M Buffi, Massimo Lazzeri, SIU
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy., Unit of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy., Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy - ., Division of Urology, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy., Department of Oncological Urology, Careggi University Hospital, Florence, Italy., Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy., IRCCS Regina Elena National Cancer Institute, Rome, Italy., Department of Urology, IRCCS INRCA, Ancona, Italy., Department of Urology and Renal Transplantation, Policlinico Foggia, University of Foggia, Foggia, Italy., Unit of Robotic and Mini Invasive Urology, Tor Vergata University, Rome, Italy., Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy., Section of Urology, Department of Human and Pediatric Pathology Gaetano Barresi, University of Messina, Messina, Italy., Unit of Urology, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy., Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.