Focal therapy - An evolving treatment paradigm for prostate cancer

Focal therapy for prostate cancer has been proposed as a potential middle ground between active surveillance and radical therapies in patients with clinically localised, low-volume, low-grade disease. Focal therapy with curative intent, aimed at ablating all identified disease, has been agreed upon as an important first step for proof-of-concept. Current consensus also recognises the possibility of use of focal therapy to treat significant disease only while leaving insignificant disease untreated, considerably expanding the number of potential candidates. Transperineal mapping biopsy and multi-parametric magnetic resonance imaging (MRI) currently are the best tools available for mapping disease within the prostate and thus demonstrate the most promise with regards to identifying appropriate candidates for focal therapy. Experience with focal therapeutic modalities, including cryotherapy and high-intensity focused ultrasound (HIFU), has generally been limited to small prospective case series. Preliminary results, however, appear promising, demonstrating good oncological control while limiting morbidity in the form of urinary incontinence and erectile dysfunction. Focal therapy, however, remains experimental at this time, with many challenges to overcome before it can be considered ready for widespread implementation.