Primary Focal Therapy for Localized Prostate Cancer: A Review of the Literature

BACKGROUND: Currently established treatment strategies for localized prostate cancer (PCa) include active surveillance and whole-gland treatments, such as radical prostatectomy and radiation therapy. These whole-gland treatments are not uncommonly associated with significant morbidity. Recent studies suggest that a single index lesion drives the disease progression in most cases. With improvements in pretreatment imaging modalities such as multiparametric MRI, the prostate's index lesion can often be accurately localized and targeted. METHODS: We performed a review of focal therapies for PCa, focusing on oncologic and functional outcomes. RESULTS: Several modalities for focal therapy approaches are under investigation. Focal therapy of PCa is a rapidly developing area of research. In comparison with whole-gland treatment, it is clear that short- and intermediate-term functional and quality-of-life outcomes are excellent with focal therapies. However, only intermediate-term surrogate oncologic outcomes are available for specific focal treatments such as high-intensity focused ultrasound and cryoablation. For many other modalities such as irreversible electroporation, only follow-up biopsy information is available. CONCLUSIONS: This review discusses the rationale for focal prostate treatment, describes the current state of the literature, and lists potential advantages and drawbacks to various therapeutic modalities.