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Updated: Jan 8, 2026
Focal Laser Ablation of Prostate Cancer: An Office Procedure
Published on: March 30, 2021
Magnetic Resonance Imaging-guided Focal Boost to Intraprostatic Lesions Using External Beam Radiotherapy for
Darren M C Poon1, Jing Yuan2, Bin Yang3
1Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong Special Administrative Region.
Context:
It is anticipated that a focal boost to intraprostatic lesions (IPLs) using external beam radiotherapy (EBRT) guided by magnetic resonance imaging (MRI) will increase biochemical disease-free survival (bDFS) without increasing toxicity in the treatment of localized prostate cancer (PC).
Objective:
To systematically review clinical outcomes for MRI-guided EBRT focal boost to IPLs.
Evidence Acquisition:
Three independent reviewers conducted literature searches in three databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The inclusion criteria were original English-language articles from 2000 to 2021 on prospective studies of patients with localized PC (n > 10) receiving an MRI-guided EBRT focal boost to IPLs. The main outcomes and measures were safety, gastrointestinal (GI)/genitourinary (GU) toxicities, quality of life, and biochemical disease outcomes. Weighted random-effects meta-analyses were conducted. Heterogeneity was assessed using the I2 statistic. Publication bias was assessed via funnel plots.
Evidence Synthesis:
Seventeen studies (1290 patients) were included. There were heterogeneities in patient risk category (low risk, 63; intermediate risk, 532; high risk, 695), MRI utilization, and treatment planning and delivery. All studies reported good safety, with estimated rates of 7.5%/7.0% (95% confidence interval [CI] 4.0-12.1%/2.8-12.8%) and 0.1%/0.2% (95% CI 0-0.4%/0-1.1%) for acute/late cumulative grade ≥2 and grade ≥3 gastrointestinal toxicities, and 29.5%/16.0% (95% CI 17.6-43.0%/8.3-25.7%) and 0.4%/1.3% (95% CI 0.0-1.3%/0.3-3.0%) for acute/late grade ≥2 and grade ≥3 genitourinary toxicities, respectively. Across patients in focal boost studies with follow-up >5 yr, bDFS was 92.4% (95% CI 84.5-97.7%). The overall bDFS was 95.0% (95% CI 91.9-97.4%) regardless of follow-up duration.
Conclusions:
MRI-guided EBRT focal boost to IPLs in localized PC was feasible and safe, with low GI/GU toxicities and favorable biochemical disease outcomes. Level 1 evidence supports the superior bDFS of this approach over whole-prostate irradiation for standard fractionation; however, further research is required for hypofractionation and ultra-hypofractionation.
Patient Summary:
We reviewed 17 studies on the use of magnetic resonance imaging (MRI)-guided radiotherapy with delivery of a higher radiation level to lesions within the prostate that were visible on MRI. This approach was well tolerated and might offer better disease control in prostate cancer over traditional radiotherapy.
