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  • Review Article
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An update on focal therapy for prostate cancer

Nature Reviews Urology volume 13, pages 641–653 (2016)Cite this article

Subjects

Key Points

  • Focal therapy is an emerging treatment option for low-risk and intermediate-risk prostate cancer

  • Owing to the multifocal nature of prostate cancer, careful patient selection for focal therapy is integral to treatment success: patients with unifocal cancer and those with an intermediate-risk index tumour and a surrounding low-grade secondary tumour might be suitable

  • Adequate preoperative assessment that includes prostate mapping is required to exclude high-grade disease before focal therapy

  • Focal therapy modalities include cryotherapy, high-intensity focused ultrasound, laser ablation, photodynamic therapy, irreversible electroporation, radiofrequency ablation and focal brachytherapy

  • Focal therapies are associated with improved postoperative preservation of sexual and urinary function compared with radical therapies

  • Additional data from large trials are required before the definitive role of focal therapies in prostate cancer can be determined

Abstract

Globally, the increased uptake of serum PSA level screening led to an increase in the number of diagnoses of low-risk and intermediate-risk prostate cancer. Traditionally, these patients have been considered for either active surveillance programmes or radical whole-gland therapies, such as prostatectomy or radiotherapy. Focal therapy is an emerging treatment option that involves the focal ablation of prostate cancer with preservation of surrounding healthy tissue. This approach might result in reduced morbidity when compared with whole-gland therapies. In current practice, much controversy surrounds optimal patient selection and preoperative tumour localization strategies. Focal therapy modalities include cryotherapy, high-intensity focused ultrasound, laser ablation, photodynamic therapy, irreversible electroporation, radiofrequency ablation and focal brachytherapy. However, as long-term oncological data for focal therapies are lacking, formal recommendations for its use cannot be made.

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Figure 1: Metastatic properties of prostate cancer.
Figure 2: Different ablation strategies.

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Authors and Affiliations

  1. Department of Surgery, University of Melbourne, Austin Health, Studley Road, Heidelberg, 3088, Victoria, Australia

    Marlon Perera, Nishanth Krishnananthan & Nathan Lawrentschuk

  2. Department of Urology, Kaplan Medical Centre, Pasternak Street, Rehovot, 76100, Israel

    Uri Lindner

  3. Department of Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, 3000, Victoria, Australia

    Nathan Lawrentschuk

  4. Olivia Newton-John Cancer Research Institute, Studley Road, Heidelberg, 3088, Victoria, Australia

    Nathan Lawrentschuk

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  1. Marlon Perera
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  2. Nishanth Krishnananthan
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  3. Uri Lindner
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  4. Nathan Lawrentschuk
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M.P. and N.K. researched data for and wrote the article. U.L. and N.L. made substantial contributions to discussions of content and reviewed and edited the manuscript before submission.

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Correspondence to Nathan Lawrentschuk.

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Perera, M., Krishnananthan, N., Lindner, U. et al. An update on focal therapy for prostate cancer. Nat Rev Urol 13, 641–653 (2016). https://doi.org/10.1038/nrurol.2016.177

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