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  • Review Article
  • Clinical Research
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Focal prostate cancer therapy in the era of multiparametric MRI: a review of options and outcomes

Prostate Cancer and Prostatic Diseases volume 26, pages 218–227 (2023)Cite this article

Subjects

Abstract

Background

The goal of prostate cancer focal therapy is to achieve oncologic control while reducing the rate of adverse events associated with whole-gland treatments. Numerous focal therapy modalities are currently available with early data demonstrating highly variable rates of cancer control and preservation of sexual/urinary function.

Methods

All English language clinical trial publications evaluating various focal therapies for localized prostate cancer were reviewed. The literature search was limited to studies from the modern era of MRI-guided treatment, as MRI is hypothesized to improve tumor localization and targeting. Primary outcomes were post-treatment cancer-free rates, in-field/out-of-field recurrence rates, and rates of conversion to radical therapy. Secondary outcomes were related to functional status and adverse events.

Results

Numerous focal therapies were identified with clinical data including high-intensity focused ultrasound, transurethral ultrasound ablation, focal laser ablation, focal cryotherapy, irreversible electroporation, and photodynamic therapy. Recurrence rates among all technologies were low to moderate (0–51%) and rates of freedom from radical treatment were highly variable (46–98%). Rates of erectile dysfunction and incontinence generally ranged from 0 to 44% and 0 to 12%, respectively, with variability between focal therapy modalities. Caution should be exercised when comparing studies as outcomes are strongly associated with patient selection. No individual focal therapy is currently recommended by society guidelines. Randomized controlled trials are ongoing in search of a standard of care.

Conclusion

For localized MRI-visible prostate cancer, early clinical trial data demonstrate that focal therapy can provide good to moderate cancer control while having preferable side effect profiles compared to whole-gland treatments. While current studies do not make head-to-head comparisons between technologies, early data suggest a potential for these technologies to provide adequate cancer control in a well-selected patient population. The oncologic outcomes of some focal therapies appear promising; however, longer-term follow-up data are needed to assess the durability of early outcomes.

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Fig. 1: Focal therapy publications selected for analysis.

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  1. These authors contributed equally: John R. Heard, Aurash Naser-Tavakolian

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  1. Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    John R. Heard, Aurash Naser-Tavakolian, Michael Nazmifar & Michael Ahdoot

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JRH was responsible for collecting and reviewing journal articles, interpreting data, creating summary tables, and writing the manuscript. AN was responsible for interpreting data, editing summary tables, and editing the manuscript. MN provided feedback on the manuscript. MA was responsible for designing the review protocol, editing summary tables, editing the manuscript, and providing feedback.

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Heard, J.R., Naser-Tavakolian, A., Nazmifar, M. et al. Focal prostate cancer therapy in the era of multiparametric MRI: a review of options and outcomes. Prostate Cancer Prostatic Dis 26, 218–227 (2023). https://doi.org/10.1038/s41391-022-00501-0

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