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Oncological results and cancer control definition in focal therapy for Prostate Cancer: a systematic review

Prostate Cancer and Prostatic Diseases (2023)Cite this article

Subjects

Abstract

Introduction

Focal therapy (FT) is a promising alternative to whole-gland treatments for Localized Prostate Cancer. Ten different FT modalities have been described in literature. However, FT is not yet recommended by the International Guidelines, due to the lack of robust data on Oncological Outcomes. The objective of our Narrative Review is to evaluate the oncological profile of the available FT modalities and to offer a comprehensive overview of the definitions of Cancer Control for FT.

Material and methods

Literature search was performed on 21st February 2023 using PubMed, EMBASE, and Scopus, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Articles reporting whole gland-treatments were excluded. All articles reporting oncological outcomes were included.

Results

One-hundred-twenty-four studies, reporting data on more than 8000 patients treated with FT, were included. Overall, 40 papers were on High Intensity Focal Ultrasound (HIFU), 24 on Focal Cryotherapy, 13 on Irreversible Electroporation (IRE), 11 on Focal brachytherapy, 10 on Focal Laser Ablation (FLA), 8 on Photo-Dynamic Therapy (PDT), 3 on Microwave ablation, 3 on Robotic Partial Prostatectomy, 2 on bipolar Radio Frequency Ablation (bRFA), 1 on Prostatic Artery Embolization (PAE) and 9 comparative papers. Overall, the Biochemical Recurrence (BCR) rate ranged from 0% (Focal Brachytherapy) to 67.5% (HIFU); the Salvage treatment rate ranged from 1% (IRE) to 54% (HIFU) considering re-treatment with FT and from 0% (Focal Brachytherapy) to 66.7% considering standard Radical Treatments. There is no univocal definition of Cancer Control, however the “Phoenix criteria” for BCR were the most commonly used.

Conclusions

FT is a promising alternative treatment for localized prostate cancer in terms of Oncological Outcomes, however there is a wide heterogeneity in the definition of cancer control, the reporting of oncological outcomes and a lack of high-quality clinical trials. Solid comparative studies with standard treatments and an unambiguous consensus on how to describe Cancer Control in the field of Focal Therapy are needed.

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Fig. 1: PRISMA flowchart.

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Data availability

The online version contains supplementary material, including the list of all articles retrieved and tables reporting information about these studies.

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Author information

Author notes

  1. These authors contributed equally: Rossella Nicoletti, Andrea Alberti.

Authors and Affiliations

  1. Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy

    Rossella Nicoletti, Andrea Alberti, Riccardo Campi, Giulio Raffaele Resta, Edoardo Dibilio, Sergio Serni & Mauro Gacci

  2. Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy

    Rossella Nicoletti, Andrea Alberti, Riccardo Campi, Giulio Raffaele Resta, Edoardo Dibilio, Sergio Serni & Mauro Gacci

  3. S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China

    Rossella Nicoletti, Chi Hang Yee, Peter Ka-Fung Chiu, Chi Fai NG & Jeremy Yuen Chun Teoh

  4. Urology Division, Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy

    Daniele Castellani

  5. Department of Urology, Beijing United Family Hospital and Clinics, Beijing, 100015, China

    Kai Zhang

  6. Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong, China

    Darren M. C. Poon

  7. Urology Unit, San Giuseppe Hospital, Multimedica Group, Milan, Italy

    Giacomo Maria Pirola

  8. Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy

    Giuseppe Chiacchio, Demetra Fuligni, Carlo Brocca, Carlo Giulioni & Virgilio De Stefano

  9. Ng Teng Fong General Hospital (NUHS), Singapore, Singapore

    Vineet Gauhar

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  1. Rossella Nicoletti
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Contributions

RN and AA were responsible for interpreting data, editing and revise the tables, write the paper. DC, CHY, KZ, DP, PC and RC were responsible for interpreting data, editing summary tables, and editing the manuscript. DC and JYCT were responsible for designing the review protocol, coordinate the group and supervise the project. GRR, ED, GMP, GC, DF, CB, CG and VDS were responsible for collecting and reviewing journal articles, editing summary tables. SS, VG, CFN provided feedback on the manuscript.

Corresponding author

Correspondence to Jeremy Yuen Chun Teoh.

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Competing interests

The authors declare no competing interests.

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As this is a systematic review, institutional review board or patient consent were not required. As for all systematic reviews, the patients presented in this systematic review have been previously reported.

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Appendices

Appendix 1 – Complete research strategy

Date: 21 February 2023

Search strategy for PubMed

(focal brachytherapy [title/abstract] OR Irreversible Electroporation [title/abstract] OR High-Intensity Focused Ultrasound [title/abstract] OR cryotherapy [title/abstract] OR microwave ablation [title/abstract] OR partial prostatectomy [title/abstract] OR focal laser therapy [title/abstract] OR photodynamic therapy [title/abstract] OR radiofrequency ablation [title/abstract]) AND (“prostate” [title/abstract] OR “prostatic” [title/abstract]) AND (“cancer” [title/abstract] OR “tumor” [title/abstract])

Search strategy for EMBASE

(‘focal brachytherapy’ OR ‘Irreversible Electroporation’ OR ‘High-Intensity Focused Ultrasound’ OR ‘cryotherapy’ OR ‘microwave ablation’ OR ‘partial prostatectomy’ OR ‘focal laser therapy’ OR ‘photodynamic therapy’ OR ‘radiofrequency ablation’) AND (‘prostate’ OR ‘prostatic’) AND (‘cancer’ OR ‘tumor’)

Search strategy for Scopus

(focal brachytherapy OR Irreversible Electroporation OR High-Intensity Focused Ultrasound OR cryotherapy OR microwave ablation OR partial prostatectomy OR focal laser therapy OR photodynamic therapy OR radiofrequency ablation) AND (prostate OR prostatic) AND (cancer OR tumor)

Appendix 2 - Complete list of included papers, sorted by modality (n = 124)

High Intensity Focused Ultrasound (HIFU) (n = 40)

  1. 1.

    Dellabella M, Branchi A, Di Rosa M, Pucci M, Gasparri L, Claudini R, et al. Oncological and functional outcome after partial prostate HIFU ablation with focal-one®: a prospective single-center study. Prostate Cancer Prostatic Dis. 2021;24:1189–1197.

  2. 2.

    Annoot A, Olivier J, Valtille P, Deken V, Leroy X, Puech P, et al. Extra-target low-risk prostate cancer: implications for focal high-intensity focused ultrasound of clinically significant prostate cancer. World J Urol. 2019;37:261–268.

  3. 3.

    Rischmann P, Gelet A, Riche B, Villers A, Pasticier G, Bondil P, et al. Focal high intensity focused ultrasound of unilateral localized prostate cancer: a prospective multicentric hemiablation study of 111 patients. Eur Urol. 2017;71:267–273.

  4. 4.

    Glybochko P V, Amosov A V, Krupinov GE, Petrovskii N V, Lumpov IS. Hemiablation of localized prostate cancer by high-intensity focused ultrasound: a series of 35 cases. Oncology. 2019;97:44–48.

  5. 5.

    Ganzer R, Hadaschik B, Pahernik S, Koch D, Baumunk D, Kuru T, et al. Prospective multicenter phase II study on focal therapy (hemiablation) of the prostate with high intensity focused ultrasound. J Urol. 2018;199:983–989.

  6. 6.

    Tay KJ, Cheng CWS, Lau WKO, Khoo J, Thng CH, Kwek, JW. Focal therapy for prostate cancer with in-bore MR-guided focused ultrasound: two-year follow-up of a phase I trial-complications and functional outcomes. Radiology. 2017;285:620–628.

  7. 7.

    van Velthoven R, Aoun F, Marcelis Q, Albisinni S, Zanaty M, Lemort M, et al. A prospective clinical trial of HIFU hemiablation for clinically localized prostate cancer. Prostate Cancer Prostatic Dis. 2016;19:79–83.

  8. 8.

    Reddy D, Peters M, Shah TT, van Son M, Tanaka MB, Huber PM, et al. Cancer control outcomes following focal therapy using high-intensity focused ultrasound in 1379 men with nonmetastatic prostate cancer: a multi-institute 15-year experience. Eur Urol. 2022;81:407–413.

  9. 9.

    Abreu AL, Peretsman S, Iwata A, Shakir A, Iwata T, Brooks J, et al. High intensity focused ultrasound hemigland ablation for prostate cancer: initial outcomes of a United States Series. J Urol. 2020;204:741–747.

  10. 10.

    Dickinson L, Ahmed HU, Hindley RG, McCartan N, Freeman A, Allen C, et al. Prostate-specific antigen vs. magnetic resonance imaging parameters for assessing oncological outcomes after high intensity-focused ultrasound focal therapy for localized prostate cancer. Urol Oncol. 2017;35:30.e9–30.e15.

  11. 11.

    Feijoo ERC, Sivaraman A, Barret E, Sanchez-Salas R, Galiano M, Rozet F, et al. Focal high-intensity focused ultrasound targeted hemiablation for unilateral prostate cancer: a prospective evaluation of oncologic and functional outcomes. Eur Urol. 2016;69:214–220.

  12. 12.

    Hong SK, Lee H. Outcomes of partial gland ablation using high intensity focused ultrasound for prostate cancer. Urol Oncol. 2022;40:193.e1–193.e5.

  13. 13.

    Bass R, Fleshner N, Finelli A, Barkin J, Zhang L, Klotz L. Oncologic and functional outcomes of partial gland ablation with high intensity focused ultrasound for localized prostate cancer. J Urol. 2019;201:113–119.

  14. 14.

    Shoji S, Hiraiwa S, Uemura K, Nitta M, Hasegawa M, Kawamura Y, et al. Focal therapy with high-intensity focused ultrasound for the localized prostate cancer for Asian based on the localization with MRI-TRUS fusion image-guided transperineal biopsy and 12-cores transperineal systematic biopsy: prospective analysis of oncolo. Int J Clin Oncol. 2020;25:1844–1853.

  15. 15.

    Nahar B, Bhat A, Reis IM, Soodana-Prakash N, Becerra MF, Lopategui D, et al. Prospective evaluation of focal high intensity focused ultrasound for localized prostate cancer. J Urol. 2020;204:483–489.

  16. 16.

    Komura K, Inamoto T, Black PC, Fujisue Y, Katsuoka Y, Watsuji T, et al. Clinically significant urethral stricture and/or subclinical urethral stricture after high-intensity focused ultrasound correlates with disease-free survival in patients with localized prostate cancer. Urol Int. 2011;87:276–281.

  17. 17.

    Rosenhammer B, Niessen C, Rotzinger L, Reiss J, Schnabel MJ, Burger M, et al. Oncological outcome and value of postoperative magnetic resonance imaging after focal high-intensity focused ultrasound therapy for prostate cancer. Urol Int. 2019;103:270–278.

  18. 18.

    Rompré-Brodeur A, Marcq G, Tholomier C, Fugaru I, Loutochin O, Anidjar M, et al. Role of systematic control biopsies following partial gland ablation with high-intensity focused ultrasound for clinically significant prostate cancer. J Urol. 2021;206:1177–1183.

  19. 19.

    Huber PM, Afzal N, Arya M, Boxler S, Dudderidge T, Emberton M, et al. Focal HIFU therapy for anterior compared to posterior prostate cancer lesions. World J Urol. 2021;39:1115–1119.

  20. 20.

    von Hardenberg J, Westhoff N, Baumunk D, Hausmann D, Martini T, Marx A, et al. Prostate cancer treatment by the latest focal HIFU device with MRI/TRUS-fusion control biopsies: a prospective evaluation. Urol Oncol Semin Orig Investig. 2018;36:401.e1–401.e9.

  21. 21.

    Johnston MJ, Emara A, Noureldin M, Bott S, Hindley RG. Focal high-intensity focussed ultrasound partial gland ablation for the treatment of localized prostate cancer: a report of medium-term outcomes from a single-center in the United Kingdom. Urology. 2019;133:175–181.

  22. 22.

    Ghai S, Finelli A, Corr K, Chan R, Jokhu S, Li X, et al. MRI-guided focused ultrasound ablation for localized intermediate-risk prostate cancer: early results of a phase II trial. Radiology.2021;298:695–703.

  23. 23.

    Uchida T, Ohkusa H, Nagata Y, Hyodo T, Satoh T, Irie A. Treatment of localized prostate cancer using high-intensity focused ultrasound. BJU Int. 2006;97:56–61.

  24. 24.

    Ganzer R, Rogenhofer S, Walter B, Lunz J-C, Schostak M, Wieland WF, et al. PSA nadir is a significant predictor of treatment failure after high-intensity focussed ultrasound (HIFU) treatment of localised prostate cancer. Eur Urol. 2008;53:547–553.

  25. 25.

    Blana A, Murat FJ, Walter B, Thuroff S, Wieland WF, Chaussy C, et al. First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer. Eur Urol. 2008;53:1194–1201.

  26. 26.

    Stabile A, Orczyk C, Hosking-Jervis F, Giganti F, Arya M, Hindley RG, et al. Medium-term oncological outcomes in a large cohort of men treated with either focal or hemi-ablation using high-intensity focused ultrasonography for primary localized prostate cancer. BJU Int. 2019;124:431–440.

  27. 27.

    Muto S, Yoshii T, Saito K, Kamiyama Y, Ide H, Horie S. Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. Jpn J Clin Oncol. 2008;38:192–199.

  28. 28.

    Westhoff N, Ernst R, Kowalewski KF, Schmidt L, Worst TS, Michel MS, et al. Treatment decision satisfaction and regret after focal HIFU for localized prostate cancer. World J Urol. 2021;39:1121–1129.

  29. 29.

    Misraï V, Rouprêt M, Chartier-Kastler E, Comperat E, Renard-Penna R, Haertig A, et al. Oncologic control provided by HIFU therapy as single treatment in men with clinically localized prostate cancer. World J Urol. 2008 Oct;26(5):481–5. https://doi.org/10.1007/s00345-008-0286-8. Epub 2008 Jun 26. PMID: 18581118.

  30. 30.

    Westhoff N, Ernst R, Kowalewski K-F, Derigs F, Neuberger M, Nörenberg D, et al. Medium-term Oncological Efficacy and Patient-reported Outcomes After Focal High-intensity Focused Ultrasound: The FOXPRO Trial. Eur Urol Focus. 2022. https://doi.org/10.1016/j.euf.2022.10.006.

  31. 31.

    Horiuchi A, Muto S, Horie S. Holmium laser enucleation of the prostate followed by high-intensity focused ultrasound treatment for patients with huge prostate adenoma and localized prostate cancer: 5-Year follow-up. Prostate Int. 2016;4:49–53.

  32. 32.

    Maestroni U, Dinale F, Minari R, Salsi P, Ziglioli F. High-intensity focused ultrasound for prostate cancer: long-term followup and complications rate. Adv Urol. 2012;2012:960835.

  33. 33.

    Van Velthoven R, Aoun F, Limani K, Narahari K, Lemort M, Peltier A. Primary Zonal High Intensity Focused Ultrasound for Prostate Cancer: Results of a Prospective Phase IIa Feasibility Study. Prostate Cancer. 2014;2014:756189.

  34. 34.

    Yee C-H, Chiu PK-F, Teoh JY-C, Ng C-F, Chan C-K, Hou S-M. High-intensity focused ultrasound (HIFU) focal therapy for localized prostate cancer with MRI-US fusion platform. Adv Urol. 2021;2021:7157973.

  35. 35.

    Ghai S, Finelli A, Corr K, Chan R, Jokhu S, Li X, et al. MRI-guided focused ultrasound ablation for localized intermediate-risk prostate cancer: early results of a phase II trial. Radiology. 2021;298(3):695-703.

  36. 36.

    Ahmed HU, Dickinson L, Charman S, Weir S, McCartan N, Hindley RG et al. Focal Ablation Targeted to the Index Lesion in Multifocal Localised Prostate Cancer: A Prospective Development Study. Eur Urol. 2015;68:927–936.

  37. 37.

    Bacchetta F, Martins M, Regusci S, Jichlinski P, Meuwly JY, Lucca I, et al. The utility of intraoperative contrast-enhanced ultrasound in detecting residual disease after focal HIFU for localized prostate cancer. Urol Oncol. 2020;38(11):846 e1–e7.

  38. 38.

    Sumitomo M, Asakuma J, Yoshii H, Sato A, Horiguchi A, Ito K, et al. Anterior perirectal fat tissue thickness is a strong predictor of recurrence after high-intensity focused ultrasound for prostate cancer. Int J Urol. 2010;17(9):776–82.

  39. 39.

    El Fegoun AB, Barret E, Prapotnich D, Soon S, Cathelineau X, Rozet F, et al. Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly. A feasibility study with 10 years follow-up. Int Braz J Urol. 2011;37(2):213–9; discussion 20-2.

  40. 40.

    Stabile A, Orczyk C, Giganti F, Moschini M, Allen C, Punwani S, et al. The Role of Percentage of Prostate-specific Antigen Reduction After Focal Therapy Using High-intensity Focused Ultrasound for Primary Localised Prostate Cancer. Results from a Large Multi-institutional Series. Eur Urol. 2020;78(2):155–60.

    Cryotherapy (n = 24).

  41. 41.

    Tan WP, Chang A, Sze C, Polascik TJ. Oncological and functional outcomes of patients undergoing individualized partial gland cryoablation of the prostate: a single-institution experience. J Endourol. 2021;35:1290–1299.

  42. 42.

    Ward JF, Jones JS. Focal cryotherapy for localized prostate cancer: a report from the national Cryo On-Line Database (COLD) Registry. BJU Int. 2012;109:1648–1654.

  43. 43.

    Bahn D, de Castro Abreu AL, Gill IS, Hung AJ, Silverman P, Gross ME, et al. Focal cryotherapy for clinically unilateral, low-intermediate risk prostate cancer in 73 men with a median follow-up of 3.7 years. Eur Urol. 2012;62:55–63.

  44. 44.

    Tokuda B, Yamada K, Takahata A, Fujihara A, Iwata T, Ukimura O, et al. Time-course changes in multiparametric magnetic resonance imaging following focal cryotherapy for localized prostate cancer: Initial experience. Eur J Radiol. 2023;160:110714.

  45. 45.

    Marra G, Soeterik T, Oreggia D, Tourinho-Barbosa R, Moschini M, Filippini C, et al. Long-term outcomes of focal cryotherapy for low- to intermediate-risk prostate cancer: results and matched pair analysis with active surveillance. Eur Urol Focus. 2022;8:701–709.

  46. 46.

    Baskin A, Charondo LB, Balakrishnan A, Cowan JE, Cooperberg MR, Carroll PR, et al. Medium term outcomes of focal cryoablation for intermediate and high risk prostate cancer: MRI and PSA are not predictive of residual or recurrent disease. Urol Oncol. 2022;40:451.e15–451.e20.

  47. 47.

    Kongnyuy M, Lipsky MJ, Islam S, Robins DJ, Hager S, Halpern DM et al. Predictors of biochemical recurrence after primary focal cryosurgery (hemiablation) for localized prostate cancer: a multi-institutional analytic comparison of Phoenix and Stuttgart criteria. Urol Oncol. 2017;35:530.e15–530.e19.

  48. 48.

    Shah TT, Peters M, Eldred-Evans D, Miah S, Yap T, Faure-Walker NA, et al. Early-medium-term outcomes of primary focal cryotherapy to treat nonmetastatic clinically significant prostate cancer from a prospective multicentre registry. Eur Urol. 2019;76:98–105.

  49. 49.

    Fernández-Pascual E, Manfredi C, Martín C, Martínez-Ballesteros C, Balmori C, Lledó-García E, et al. mpMRI-US fusion-guided targeted cryotherapy in patients with primary localized prostate cancer: a prospective analysis of oncological and functional outcomes. Cancers. 2022;14. https://doi.org/10.3390/cancers14122988.

  50. 50.

    Aker MN, Brisbane WG, Kwan L, Gonzalez S, Priester AM, Kinnaird A, et al. Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes. Cancer Med. 2023. https://doi.org/10.1002/cam4.5692.

  51. 51.

    Wysock JS, Becher E, Gogaj R, Velazquez N, Lepor H. Early oncological control following partial gland cryo-ablation: a prospective experience specifying reflex MRI guided biopsy of the ablation zone. Prostate Cancer Prostatic Dis. 2021;24:114–119.

  52. 52.

    Mercader C, Musquera M, Franco A, Alcaraz A, Ribal MJ. Primary cryotherapy for localized prostate cancer treatment. Aging Male 2021;23:1460–1466.

  53. 53.

    Basourakos SP, Al Hussein Al Awamlh B, Bianco FJ, et al. Feasibility of in-office MRI-targeted partial gland cryoablation for prostate cancer: an IDEAL stage 2A study. BMJ Surg Interv Health Technologies 2020;2:e000056. https://doi.org/10.1136/bmjsit-2020-000056.

  54. 54.

    Chuang R, Kinnaird A, Kwan L, Sisk A, Barsa D, Felker E, et al. Hemigland Cryoablation of Clinically Significant Prostate Cancer: Intermediate-Term Followup via Magnetic Resonance Imaging Guided Biopsy. J Urol 2020;204:941–949.

  55. 55.

    Gregg JR, Borregales LD, Choi H, Lozano M, McRae SE, Venkatesan AM, et al. Prospective trial of regional (hockey-stick) prostate cryoablation: oncologic and quality of life outcomes. World J Urol. 2021;39: 3259–3264.

  56. 56.

    Sze C, Tsivian E, Tay KJ, Schulman AA, Davis LG, Gupta RT, et al. Anterior gland focal cryoablation: Proof-of-concept primary prostate cancer treatment in select men with localized anterior cancers detected by multi-parametric magnetic resonance imaging. BMC Urol. 2019;19. https://doi.org/10.1186/s12894-019-0562-5.

  57. 57.

    Oishi M, Gill IS, Tafuri A, Shakir A, Cacciamani GE, Iwata T, et al. Hemigland Cryoablation of Localized Low, Intermediate and High Risk Prostate Cancer: Oncologic and Functional Outcomes at 5 Years. J Urol 2019;202:1188–1197.

  58. 58.

    Lian H, Zhuang J, Yang R, Qu F, Wang W, Lin T, et al. Focal cryoablation for unilateral low-intermediate-risk prostate cancer: 63-month mean follow-up results of 41 patients. Int Urol Nephrol 2016;48: 85–90.

  59. 59.

    Durand M, Barret E, Galiano M, Rozet F, Sanchez-Salas R, Ahallal Y, et al. Focal cryoablation: a treatment option for unilateral low-risk prostate cancer. BJU Int. 2014;113: 56–64.

  60. 60.

    Hale Z, Miyake M, Palacios DA, Rosser CJ. Focal cryosurgical ablation of the prostate: A single institute’s perspective. BMC Urol 2013;13. https://doi.org/10.1186/1471-2490-13-2.

  61. 61.

    Onik G, Vaughan D, Lotenfoe R, Dineen M, Brady J. The ‘male lumpectomy’: focal therapy for prostate cancer using cryoablation results in 48 patients with at least 2-year follow-up. Urol Oncol Semin Orig Investig. 2008;26:500–505.

  62. 62.

    DiBlasio CJ, Derweesh IH, Malcolm JB, Maddox MM, Aleman MA, Wake RW. Contemporary analysis of erectile, voiding, and oncologic outcomes following primary targeted cryoablation of the prostate for clinically localized prostate cancer. Int Braz J Urol. 2008;34:443–450.

  63. 63.

    Lambert EH, Bolte K, Masson P, Katz AE. Focal Cryosurgery: Encouraging Health Outcomes for Unifocal Prostate Cancer. Urology. 2007;69:1117–1120.

  64. 64.

    Bahn DK, Silverman P, Lee F, Badalament R, Bahn ED, Rewcastle JC. Focal prostate cryoablation: Initial results show cancer control and potency preservation. J Endourol. 2006;20:688–692.

    Irreversible Electroporation (IRE) (n = 13)

  65. 65.

    Guenther E, Klein N, Zapf S, Weil S, Schlosser C, Rubinsky B, et al. Prostate cancer treatment with Irreversible Electroporation (IRE): Safety, efficacy and clinical experience in 471 treatments. PLoS One. 2019;14(4):e0215093.

  66. 66.

    van den Bos W, Scheltema MJ, Siriwardana AR, Kalsbeek AMF, Thompson JE, Ting F, et al. Focal irreversible electroporation as primary treatment for localized prostate cancer. BJU Int. 2018;121:716–724.

  67. 67.

    Collettini F, Enders J, Stephan C, Fischer T, Baur ADJ, Penzkofer T, et al. Image-guided irreversible electroporation of localized prostate cancer: functional and oncologic outcomes. Radiology. 2019;292:250–257.

  68. 68.

    Ting F, Tran M, Böhm M, Siriwardana A, Van Leeuwen PJ, Haynes AM, et al. Focal irreversible electroporation for prostate cancer: functional outcomes and short-term oncological control. Prostate Cancer Prostatic Dis. 2016;19:46–52.

  69. 69.

    Murray KS, Ehdaie B, Musser J, Mashni J, Srimathveeravalli G, Durack JC, et al. Pilot study to assess safety and clinical outcomes of irreversible electroporation for partial gland ablation in men with prostate cancer. J Urol. 2016;196:883–890.

  70. 70.

    Blazevski A, Amin A, Scheltema MJ, Balakrishnan A, Haynes A-M, Barreto D, et al. Focal ablation of apical prostate cancer lesions with irreversible electroporation (IRE). World J Urol 2021;39:1107–1114.

  71. 71.

    Valerio M, Dickinson L, Ali A, Ramachadran N, Donaldson I, Mccartan N, et al. Nanoknife electroporation ablation trial: a prospective development study investigating focal irreversible electroporation for localized prostate cancer. J Urol. 2017;197(3 Pt 1):647–654.

  72. 72.

    Valerio M, Stricker PD, Ahmed HU, Dickinson L, Ponsky L, Shnier R, et al. Initial assessment of safety and clinical feasibility of irreversible electroporation in the focal treatment of prostate cancer. Prostate Cancer Prostatic Dis. 2014;17:343–347.

  73. 73.

    Wang H, Xue W, Yan W, Yin L, Dong B, He B, et al. Extended focal ablation of localized prostate cancer with high-frequency irreversible electroporation: a nonrandomized controlled trial. JAMA Surg. 2022;157:693–700.

  74. 74.

    Scheltema MJ, Geboers B, Blazevski A, Doan P, Katelaris A, Agrawal S, et al. Median 5-year outcomes of primary focal irreversible electroporation for localised prostate cancer. BJU Int. 2022. https://doi.org/10.1111/bju.15946.

  75. 75.

    Shin D, Yoon CE, Kwon HJ, Moon HW, Park YH, Cho HJ, et al. Irreversible electroporation for prostate cancer using PSMA PET-CT. Prostate Int. 2022. https://doi.org/10.1016/j.prnil.2022.08.004.

  76. 76.

    Enikeev D, Taratkin M, Morozov A, et al. Focal irreversible electropo- ration for localized prostate cancer management: prospective as- sessment of efficacy and safety. Minerva Urol Nefrol. 2020;72:644–5.

  77. 77.

    Giganti F, Stabile A, Giona S, et al. Prostate cancer treated with irreversible electroporation: MRI-based volumetric analysis and oncological outcome. Magn Reson Imaging. 2019;58:143–7.

    Focal Brachytherapy (n = 11)

  78. 78.

    Fischbach F, Hass P, Schindele D, Genseke P, Geisendorf L, Stehning C, et al. MRI targeted single fraction HDR Brachytherapy for localized prostate carcinoma: a feasibility study of focal radiation therapy (ProFocAL). Eur Radiol. 2020;30:2072–2081.

  79. 79.

    Graff P, Portalez D, Lusque A, Brun T, Aziza R, Khalifa J, et al. IDEAL 2a Phase II Study of Ultrafocal Brachytherapy for Low- and Intermediate-risk Prostate Cancer. Int J Radiat Oncol Biol Phys. 2018;102:903–911.

  80. 80.

    Mahdavi SS, Spadinger IT, Salcudean SE, Kozlowski P, Chang SD, Ng T, et al. Focal application of low-dose-rate brachytherapy for prostate cancer: a pilot study. J Contemp Brachytherapy 2017;9:197–208.

  81. 81.

    Peters M, van Son MJ, Moerland MA, Kerkmeijer LGW, Eppinga WSC, Meijer RP, et al. MRI-guided ultrafocal HDR brachytherapy for localized prostate cancer: median 4-year results of a feasibility study. Int J Radiat Oncol Biol Phys. 2019;104:1045–1053.

  82. 82.

    Prada PJ, Cardenal J, García Blanco A, Andreescu J, Ferri M, Anchuelo J, et al. Focal high-dose-rate brachytherapy for localized prostate cancer: toxicity and preliminary biochemical results. Strahlentherapie und Onkol Organ der Dtsch Rontgengesellschaft [et al.] 2020;196:222–228.

  83. 83.

    Anderson E, Smyth LML, O’Sullivan R, Ryan A, Lawrentschuk N, Grummet J, et al. Focal low dose-rate brachytherapy for low to intermediate risk prostate cancer: preliminary experience at an Australian institution. Transl Androl Urol. 2021;10:3591–3603.

  84. 84.

    Cosset J-M, Cathelineau X, Wakil G, Pierrat N, Quenzer O, Prapotnich D, et al. Focal brachytherapy for selected low-risk prostate cancers: a pilot study. Brachytherapy 2013;12:331–337.

  85. 85.

    Hass P, Fischbach F, Pech M, Gawish A. Feasibility of MRI targeted single fraction HDR brachytherapy for localized prostate carcinoma: ProFocAL-study. J Cancer Res Clin Oncol. 2022. https://doi.org/10.1007/s00432-022-04491-3.

  86. 86.

    Nguyen PL, Chen M-H, Zhang Y, Tempany CM, Cormack RA, Beard CJ, et al. Updated results of magnetic resonance imaging guided partial prostate brachytherapy for favorable risk prostate cancer: implications for focal therapy. J Urol. 2012;188:1151–1156.

  87. 87.

    Saito K, Matsuoka Y, Toda K, Yoshida S, Yokoyama M, Yoshimura R, et al. Medium-term oncological and functional outcomes of hemi-gland brachytherapy using iodine-125 seeds for intermediate-risk unilateral prostate cancer. Brachytherapy. 2021;20:842–848.

  88. 88.

    Ta M-H, Nunes-Silva I, Barret E, Renard-Penna R, Rozet F, Mombet A, et al. Focal brachytherapy for localized prostate cancer: midterm outcomes. Pract Radiat Oncol. 2021;11:e477–e485.

    Focal Laser Ablation (FLA) (n = 10)

  89. 89.

    Chao B, Lepor H. 5-Year outcomes following focal laser ablation of prostate cancer. Urology. 2021;155:124–129.

  90. 90.

    Natarajan S, Raman S, Priester AM, Garritano J, Margolis DJA, Lieu P, et al. Focal laser ablation of prostate cancer: phase I clinical trial. J Urol. 2016;196:68–75.

  91. 91.

    Meneghetti I, Giardino D, Morganti R, Marino V, Menchini Fabris F, Bartoletti R et al. A single-operator experience using EchoLaser SoracteLiteTM for focal laser ablation of prostate cancer: one more arrow in the quiver for the conservative management of the disease. Arch Ital di Urol Androl organo Uff [di] Soc Ital di Ecogr Urol e Nefrol. 2022;94:406c412.

  92. 92.

    Walser E, Nance A, Ynalvez L, Yong S, Aoughsten JS, Eyzaguirre EJ, et al. Focal laser ablation of prostate cancer: results in 120 patients with low- to intermediate-risk disease. J Vasc Interv Radiol. 2019;30:401–409.e2.

  93. 93.

    Al-Hakeem Y, Raz O, Gacs Z, Maclean F, Varol C. Magnetic resonance image-guided focal laser ablation in clinically localized prostate cancer: safety and efficacy. ANZ J Surg. 2019;89:1610–1614.

  94. 94.

    Oto A, Sethi I, Karczmar G, McNichols R, Ivancevic MK, Stadler WM, et al. MR imaging-guided focal laser ablation for prostate cancer: phase I trial. Radiology. 2013;267:932–940.

  95. 95.

    Lepor H, Llukani E, Sperling D, Fütterer JJ. Complications, Recovery, and Early Functional Outcomes and Oncologic Control Following In-bore Focal Laser Ablation of Prostate Cancer. Eur Urol. 2015;68:924–926.

  96. 96.

    Mehralivand S, George AK, Hoang AN, Rais-Bahrami S, Rastinehad AR, Lebastchi AH, et al. MRI-guided focal laser ablation of prostate cancer: a prospective single-arm, single-center trial with 3 years of follow-up. Diagn Interv Radiol. 2021;27:394–400.

  97. 97.

    Barqawi A, Krughoff K, Li H, Patel NU. Initial experience of targeted focal interstitial laser ablation of prostate cancer with MRI guidance. Curr Urol. 2015;8:199–207.

  98. 98.

    Natarajan S, Jones TA, Priester AM, et al. Focal laser ablation of prostate cancer: feasibility of magnetic resonance imaging-ultra- sound fusion for guidance. J Urol. 2017;198:839–47.

    PhotoDynamic therapy (PDT) (n = 8)

  99. 99.

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Nicoletti, R., Alberti, A., Castellani, D. et al. Oncological results and cancer control definition in focal therapy for Prostate Cancer: a systematic review. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00699-7

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