Technical Aspects of Focal Therapy in Localized Prostate Cancer

Focal therapy is a compelling option for selected patients who have unilateral low-risk prostate cancer, providing an alternative between active surveillance and radical therapies by targeting the index lesion and preserving as much tissue as possible. Early feasibility studies have investigated cryotherapy, high-intensity focused ultrasound, brachytherapy, photodynamic therapy, laser therapy, irreversible electroporation and cyberknife methods, all of which have promising oncological outcomes. These various ablative techniques have resulted in limited rectal toxicity, had minor effects on urinary function and demonstrated a high rate of preserving erectile function. As a result, the primary end-point has now shifted and a new strategy needs to be set up for patient follow-up and for defining treatment failure.