Oncologic and functional outcomes of novel focal therapy methods for low-risk to intermediate-risk prostate cancer

Focal therapy has emerged as a potential treatment option that may provide similar oncological outcomes with fewer complications for low-risk to intermediate-risk prostate Cancer (PCa) compared to standard management. Our aim is to describe recent clinically studies utilizing focal therapy - specifically high-intensity focused ultrasound (HIFU), cryotherapy, irreversible electroporation (IRE), focal laser ablation (FLA), and microwave - for localized PCa.

Recent studies demonstrate that HIFU achieves high rates (81-96%) of treatment-free survival up to 36-48 months, with noninferior salvage therapy-free survival rates when compared to radical prostatectomy. Cryotherapy demonstrates similar efficacy regardless of lesion location. FLA shows 80-84% clinically significant (cs)PCa-free rates at 12-36 months. IRE achieved 71-84% negative in-field biopsy at 12 months with stable urinary and sexual function. Microwave ablation demonstrates 81-90% csPCa-free rates at 12 months with 100% complete necrosis on histopathology. Current surveillance includes novel PI-FAB and TARGET scoring systems, with high specificity and high NPV for in-field recurrence.

Focal therapy represents a promising option for localized prostate cancer, with recent studies supporting favorable short-term oncologic control and preserved functional outcomes across modalities, with novel surveillance methods available following focal therapy treatment.