Focal therapy in intermediate- and high-risk prostate cancer

Focal therapy is a treatment option for clinically localized prostate cancer, finding increased use in recent years. It is generally associated with very good functional outcome regarding pad-free continence and preservation of erections. Oncologic outcomes are controversial, especially depending on the ideal endpoint. Both the presence of clinically significant prostate cancer (csPCA) on biopsy and the absence of any whole-gland or systemic treatment as “failure-free survival” (FFS) have been used. While salvage whole-gland and systemic therapy is rare, a substantial number of patients will have csPCA on follow-up biopsies after focal therapy, either in-field or out of field. Generally, patients selected for focal therapy are considered intermediate-risk, although some patients with high-risk features have been included into focal therapy studies. With the data currently available focal therapy presents a good treatment option for patients with feasible intermediate-risk prostate cancer, interested in functional outcome, after proper counseling on the higher recurrence rate, and the need for surveillance biopsies during follow-up.