Focal Therapy for Prostate Cancer: State of the Art, Physical Principles, Potentials, and Challenges

Area of Science:

• Oncology
• Urology
• Minimally Invasive Surgery

Background:

• Localized prostate cancer (PCa) management faces challenges with overtreatment from surgery and uncertainty in active surveillance.
• A therapeutic gap exists for intermediate-risk and selected low-risk PCa patients.
• Focal therapy (FT) presents a technological solution for oncological control and organ preservation.

Purpose of the Study:

• To review the physical principles of ablative energies and radiation-based focal approaches for PCa.
• To analyze the oncological rationale, imaging innovations, and clinical applications of FT.
• To assess the current status and future directions of FT in localized PCa management.

Main Methods:

• Narrative literature review.
• Analysis of thermal, cryogenic, non-thermal, and radiation-based ablative energies.
• Examination of advancements in imaging (mpMRI) and fusion systems.

Main Results:

• Evidence supports "Index Lesion" ablation as a curative strategy for significant PCa.
• Salvage FT shows value in radio-recurrent prostate cancer.
• Innovations in mpMRI and fusion systems enhance patient selection for targeted FT.

Conclusions:

• FT is a promising organ-sparing alternative for carefully selected localized PCa patients.
• Barriers to adoption include lack of standardized criteria for therapeutic failure and inadequate PSA-based metrics.
• Long-term comparative data are needed to support universal FT adoption.