Patient Selection for Focal Therapy for Prostate Cancer

Abstract

The aim of focal therapy is to offer selected patients with prostate cancer (PCa) better control of their disease and lower treatment-related morbidity. Whole-mount prostate treatment is often associated with urinary incontinence (5–20 %), erectile dysfunction (30–70 %), and bowel toxicity (5–10 %). Treating the correct population by proper patient selection is certainly the cornerstone of this new prostate cancer treatment strategy. Although there are still no high-level evidence studies at the moment, several retrospective or noncontrolled prospective series draw the lines for inclusion and exclusion criteria. The selection has to balance between the risk of overtreatment of nonthreatening disease where active surveillance has proven to be a safe strategy, and an inefficient strategy for potentially harmful disease that might require multimodal strategies, including whole-mount prostate treatment (radical prostatectomy or external beam therapy). We base our recommendations on previous and long-running trials and three consensus meetings organized around prostate cancer focal therapy. The main features to focus on are the patient’s general health condition, classic prostate cancer criteria for risk stratification, and, more specific to focal therapy, cancer topography into the gland. At the margin of current admitted application of focal therapy but still in the field of patient selection, we mention the role of focal therapy as a salvage treatment after external beam radiation therapy or brachytherapy.