Focal therapy for prostate cancer

Nowadays the treatment paradigm for localized prostate cancer is to distinguish patients with clinically relevant cancers who may benefit from radical treatment, or perhaps an organ-sparing approach, from the remainder who may not need intervention at the time of diagnosis. We review new concepts of parenchymal preservation as possible new frontiers in the treatment armamentarium for this malignancy.

For a select cohort of patients with low-risk unifocal or unilateral prostate cancer lesions, a number of ablative treatment options for focal therapy are available with cryotherapy having the most clinical experience. Technologies that have the ability to be utilized for focal therapy include high-intensity focused ultrasound, brachytherapy, interstitial laser thermotherapy, stereotactic radio surgery, and vascular-targeted photodynamic therapy. Further basic and animal research along with the conduction of large-scale randomized clinical trials demonstrating long-term disease-free survival and quality of life outcomes are necessary.

The concept of focal therapy is evolving with the understanding of the biologic variability (clinically aggressive, significant or insignificant) of various prostate cancer lesions that may require different treatment approaches. Minimally invasive, parenchyma-preserving therapies can assume a greater role in the treatment of unilateral or unifocal lesions, representing an alternative approach to the current treatment extremes of whole-gland treatment and watchful waiting.