Evolution of the Concept of Focal Therapy for Prostate Cancer

The landscape of prostate cancer has been rapidly evolving, and technological advances in imaging and biopsy tools offer novel approaches to focal therapy. In this dynamic environment, the role of focal therapy for prostate cancer is being shaped both by advances in technology and by reconsidering the epidemiological and outcomes data for available treatments. Here we focus on the evolution of the concept of focal therapy and its potential roles in the management of prostate cancer.

Introduction

Focal therapy for prostate cancer (PCa) is a management concept whereby active therapy is delivered to malignant portion(s) of the gland, eradicating the known and targeted cancer while sparing unaffected tissue and reducing the morbidity of treatment.[1] Whole-gland therapies such as radical prostatectomy and radiation carry a significant burden of side effects, and a concern regarding active surveillance is that it potentially misses the window of opportunity for active treatment and cure. In contrast, focal therapy-which combines active treatment of the identified clinically significant disease with active surveillance of the remaining unaffected prostate tissue-offers an intermediate means of active management of PCa with potentially better-preserved quality of life for the patient.

The landscape of prostate cancer management has been rapidly evolving, with technological advances in imaging and biopsy techniques offering novel tools for focal therapy approaches.[2,3] In this dynamic environment, the role of focal therapy is still being shaped, both by the rapid introduction of new technology and through reconsideration of the evidence regarding the epidemiology of prostate cancer and available treatment options.

Here we will focus on the recent evolution of the concept of focal therapy and the potential applications of this management approach within an array of options currently available for patients with localized PCa.

Focal Therapy as the Lesser Evil

The contemporary practice of overtreatment of low-risk PCa is well documented.[4,5] Today, most men diagnosed with PCa undergo whole-gland treatment, which in some patients will be associated with significant side effects that reduce their quality of life.[6] Importantly, a recent study could not confirm an overall or cancer-specific mortality benefit for radical prostatectomy over watchful waiting in men with low-risk disease.[4] Undoubtedly, however, active intervention puts the patients at risk for potentially severe complications.

TABLE

Summary of the Available Outcomes of Focal Therapy in the Published Literature

Internal server error