Focal therapy for prostate cancer: concepts and future directions

Area of Science:

• Oncology
• Urology
• Medical Imaging

Background:

• Focal therapy for localized prostate cancer (PCa) is gaining traction due to advancements in detection and risk stratification.
• Key drivers include identifying the index lesion, enhanced PCa detection via multiparametric MRI and targeted biopsies, and novel biomarkers.
• Reducing treatment-related morbidity is recognized as a clinically meaningful endpoint, increasing interest in focal therapy.

Purpose of the Study:

• To provide an overview of the current state of focal therapy for prostate cancer.
• To discuss future directions and emerging concepts in the field of PCa focal therapy.

Main Methods:

• Review of recent developments in focal therapy modalities, primarily in phase 1 and 2 studies.
• Inclusion of Level I prospective randomized data comparing partial gland ablation with standard care.
• Discussion of advancements in imaging technologies like 7-T MRI, functional imaging, radiomics, and contrast-enhanced ultrasound.

Main Results:

• Novel focal therapy treatments demonstrate safety, feasibility, and low toxicity.
• Acceptable short-term and medium-term oncologic outcomes are reported for these novel treatments.
• Emerging imaging techniques show promise for optimizing patient selection and assessing therapeutic efficacy.

Conclusions:

• Focal therapy for PCa has evolved significantly, offering a viable option with reduced morbidity.
• Advancements in imaging will further refine patient selection and treatment monitoring.
• The pursuit of oncologic control alongside minimized treatment-related side effects will continue to drive innovation in focal PCa therapy.