Focal laser ablation in prostate cancer: a systematic review and meta-analysis

To evaluate the oncological control and functional outcomes of focal laser ablation (FLA) in the management of localised prostate cancer.

A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. An electronic search identified studies reporting outcomes of FLA for localised prostate cancer. The primary outcome was oncological control, assessed by recurrence on follow-up biopsy and prostate-specific antigen (PSA) level reduction. Secondary outcomes included adverse events and functional outcomes, specifically sexual and urinary function.

The search identified 12 studies for inclusion, including 421 patients who underwent FLA for localised prostate cancer. The rate of recurrence of clinically significant cancer on biopsy following FLA was 15% (95% confidence interval [CI] 11-20%). The mean reduction in PSA level at 12-months post-FLA was 2.3 ng/mL (95% CI 1.5-3.2 ng/mL). There was a statistically significant (P < 0.001), but not clinically significant (Cohen's d = 0.29) decrease in sexual function, and no statistically significant change in urinary function following FLA. Heterogeneity in patient selection, follow-up protocols, and definitions of recurrence limit cross-study comparisons and generalisability.

The present systematic review and meta-analysis found that FLA provides oncological control comparable to other focal therapies while preserving functional outcomes. However, the limited availability of high-quality comparative studies highlights the need for further robust studies to validate these findings.