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Focal therapy in prostate cancer: modalities, findings and future considerations

Nature Reviews Urology volume 7, pages 562–571 (2010)Cite this article

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Abstract

Focal therapy is emerging as an alternative to active surveillance for the management of low-risk prostate cancer in carefully selected patients. The aim of focal therapy is long-term cancer control without the associated morbidity that plagues all radical therapies. Different energy modalities have been used to focally ablate cancer tissue, and available techniques include cryotherapy, laser ablation, high-intensity focused ultrasound and photodynamic therapy. The majority of evidence for focal therapy has come from case series and small phase I trials, and larger cohort studies with longer follow-up are only now being commenced. More data from large trials on the safety and efficacy of focal therapy are therefore required before this approach can be recommended in men with prostate cancer; in particular, studies must confirm that no viable cells remain in the region of ablation. Focal therapy might eventually prove to be a 'middle ground' between active surveillance and radical treatment, combining minimal morbidity with cancer control and the potential for re-treatment.

Key Points

  • Focal therapy is emerging as an alternative to active surveillance in the management of low-risk, carefully selected patients with prostate cancer

  • Cryotherapy, focal laser ablation, high-intensity focused ultrasound and photodynamic therapy are the modalities currently available to focally ablate any tumor, including prostate cancer

  • MRI is emerging as a key component of the focal ablation technique as it is able to locate the tumor, provide real-time monitoring and confirm tumor ablation

  • Data from large trials on the safety and efficacy of focal therapy are required before this approach can be recommended as an option for men with prostate cancer

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Figure 1: Available ablative modalities for focal therapy of prostate cancer.
Figure 2: Peer-reviewed articles on focal therapy for prostate cancer.

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Acknowledgements

We thank Janice Yau, a student from the Division of Biomedical Communications, University of Toronto, Canada, for creating the original artwork used as the basis for Figure 1.

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  1. Department of Urology and Surgical Oncology, University of Toronto, Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto, M5G 2M9, ON, Canada

    Uri Lindner, John Trachtenberg & Nathan Lawrentschuk

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  1. Uri Lindner
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  2. John Trachtenberg
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  3. Nathan Lawrentschuk
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All three authors researched data for this article and contributed to discussion regarding the article content. The article was written by U. Lindner and N. Lawrentschuk and was reviewed and edited by T. Trachtenburg and N. Lawrentschuk before submission.

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Correspondence to Nathan Lawrentschuk.

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Lindner, U., Trachtenberg, J. & Lawrentschuk, N. Focal therapy in prostate cancer: modalities, findings and future considerations. Nat Rev Urol 7, 562–571 (2010). https://doi.org/10.1038/nrurol.2010.142

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