Identifying the best candidate for focal therapy: a comprehensive review

Area of Science:

• Urology
• Oncology
• Medical Imaging

Background:

• Focal therapy (FT) shows promise for localized prostate cancer (PCa).
• Significant variability exists in patient selection criteria for FT across studies.
• Optimal patient selection for FT in PCa requires further clarification.

Purpose of the Study:

• To review recent evidence on optimal patient selection for FT in prostate cancer.
• To synthesize current recommendations for identifying suitable candidates for FT.

Main Methods:

• Systematic literature search of the PubMed database up to December 31, 2023.
• Qualitative analysis of extracted data from relevant studies.
• Exclusion of non-relevant articles and quality assessment of included studies.

Main Results:

• No Level I evidence exists for FT patient selection in PCa.
• Multidisciplinary consensus recommends multiparametric MRI (mpMRI) and targeted biopsy.
• FT candidates should have localized, intermediate-risk (Gleason 3+4, 4+3), preferably unifocal disease with acceptable life expectancy.
• Prostate volume >50ml and erectile dysfunction do not exclude patients; PSA <20 ng/mL (ideally <10 ng/mL) is advised.
• Utility of genomic biomarkers for FT selection is currently unknown.

Conclusions:

• Focal therapy (FT) is a viable option for carefully selected localized prostate cancer (PCa) patients.
• This review offers insights into optimal patient selection strategies for FT.