Focal Therapy for Prostate Cancer

With the increasing rate of detection of localized, low-risk cancers of the prostate, new treatment strategies are required to avoid the morbidity of traditional whole-gland therapy while limiting the risk of significant disease progression. Focal therapy is a promising method of prostate cancer treatment with the potential to bridge the gap between active surveillance and radical treatment. Emerging data regarding oncological and quality of life outcomes from clinical trials are encouraging. Although the majority of contemporary-focal therapy options have yet to demonstrate comparable levels of cancer control as whole-gland or radical therapy, refinements in candidate selection, disease mapping, and accurate targeting of ablative energy to cancer foci may facilitate improvements in oncological outcomes. Some of the remaining challenges of focal therapy, including disease mapping, treatment monitoring, and evaluation at follow-up, may be addressed with advances in MRI sequencing and interpretation techniques. However, critical questions about long-term outcomes remain, which require further exploration before protocols for focal therapy in common clinical practice can be developed.