Is focal therapy an alternative to active surveillance?

Because of the widespread use of prostate-specific antigen, urologists face an increasing number of patients with small-volume, low-grade prostatic carcinoma seeking the optimal therapeutic approach. Concerns about "overdiagnosis" of prostate cancer (PCa) and consequent overtreatment of clinically insignificant tumors in combination with the significant morbidity that traditional therapies carry have resulted in questioning the need for radical treatments of PCa for selected groups of patients with low-risk PCa. Active surveillance has been introduced as a conservative management option for PCa that closely monitors patients and treats them when progression is identified. Recently, because of technological advances, focal therapy has been introduced to optimize control of low-risk cancers while minimizing the adverse events of whole-gland therapy and the anxiety associated with delayed treatment. The rationales, merits, and limitations of both active surveillance and focal therapy are highlighted in this article.