Current state of image-guided focal therapy for prostate cancer

Tourinho-Barbosa R. R., Wood B. J., Abreu A. L., Nahar B., Shin T., Guven S., ...More

World Journal of Urology, vol.39, no.3, pp.701-717, 2021 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 39 Issue: 3
  • Publication Date: 2021
  • Doi Number: 10.1007/s00345-020-03254-4
  • Journal Name: World Journal of Urology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, EMBASE, Gender Studies Database, MEDLINE
  • Page Numbers: pp.701-717
  • Keywords: Prostate cancer, Ablation techniques, Focal therapy, Localized, Outcome
  • Istanbul Medipol University Affiliated: Yes


Purpose: To review the current evidence regarding protocols and outcomes of image-guided focal therapy (FT) for prostate cancer (PCa). Methods: A literature search of the latest published studies assessing primary FT for PCa was carried out in Medline and Cochrane library databases followed by a critical review. FT modalities, follow-up strategies, and oncological and toxicity outcomes were summarized and discussed in this review. Results: Twenty-four studies with six different sources of energy met the inclusion criteria. A heterogeneity of patient selection, energy sources, treatment templates, and definitions of failure was found among the studies. While a third of patients may be found to have additional cancer burden over 3–5 years following FT, most patients will remain free of a radical procedure. The vast majority of patients maintain urinary continence and good erectile function after FT. Acute urinary retention is the most common complication, whilst severe complications remain rare. Conclusion: An increasing number of prospective studies with longer follow-up have been recently published. Acceptable cancer control and low treatment toxicity after FT have been consistently reported. Follow-up imaging and routine biopsy must be encouraged post-FT. While there is no reliable PSA threshold to predict failure after FT, reporting post-FT positive biopsies and retreatment rates appear to be standard when assessing treatment efficacy.