Focal therapy, time to join the multi-disciplinary team discussion?

Area of Science:

• Oncology
• Urology
• Medical Technology

Background:

• Organ-preserving management is standard for many solid tumors, but intermediate-risk prostate cancer options (radical treatments or active surveillance) have drawbacks.
• Radical treatments cause significant morbidity, while active surveillance involves patient anxiety and intensive monitoring.
• Focal therapy presents a promising alternative, aiming for better functional outcomes while maintaining cancer control.

Purpose of the Study:

• To review the feasibility and evidence for focal therapy in intermediate-risk prostate cancer.
• To discuss patient selection, various focal ablation techniques, and post-treatment surveillance strategies.
• To consider the integration of focal therapy into multidisciplinary team discussions and patient consultations.

Main Methods:

• Review of recent high-level evidence, including PROMIS and PRECISION trials.
• Analysis of diagnostic advancements like MRI and targeted biopsies for accurate tumor characterization.
• Evaluation of medium-term oncological and functional outcomes of focal therapy.

Main Results:

• Improved diagnostic accuracy with MRI and targeted biopsies enhances confidence in focal therapy.
• Reassuring medium-term oncological and functional outcomes support focal therapy for selected patients.
• Focal therapy is emerging as a viable management option for intermediate-risk prostate cancer.

Conclusions:

• Accurate disease characterization through advanced imaging and biopsy techniques is crucial for focal therapy success.
• Focal therapy offers a potentially superior balance of cancer control and functional preservation for intermediate-risk prostate cancer.
• The integration of focal therapy into standard clinical practice, including MDT meetings, warrants consideration.