This article was originally published here
J Endourol. 2021 Apr 13. doi: 10.1089/end.2021.0235. Online ahead of print.
Focal therapy (FT) is a promising alternative to definitive therapy for localized prostate cancer (PCa). Rather than simply monitoring cancer through active surveillance (AS) or risking the side effects of robotic radical prostatectomy (RP) it offers an intermediate solution. Azzouzi et al. examined vascular-targeted photodynamic therapy (PDT) for PCa. In this randomized, controlled clinical trial, patients with low-risk and localized PCa with no prior treatment were either assigned to a group undergoing vascular-targeted photodynamic therapy or to another group undergoing AS. Participants in the PDT group had a longer median disease progression time, lower proportion of disease progression at 24 months after treatment, and a higher proportion of negative biopsies at 24 months after treatment than the patients in the AS group. Use of PDT was associated with almost a five-fold decrease in reduction of use of definitive therapy. Cryoablation and high intensity focused ultrasound (HIFU) are additional forms of FT for localized PCa. They have been associated with a 5-year metastasis-free survival rate of up to 98% in low or intermediate risk patients. Patients undergoing salvage RP after FT may also see benefits compared to those who undergo RP after radiation therapy (RT). Ribiero et al. compared toxicity and oncological outcomes of patients who underwent salvage RP (sRP) after FT with those who underwent sRP after RT. Patients who underwent sRP after FT were found to have better continence at 12 months after surgery, almost 3 times less the rate of positive surgical margins, and lower postoperative complication rates within the first 30 days of surgery than those who had sRP after undergoing RT. Methods of FT including PDT, HIFU, and cryoablation provide an intermediate treatment option between AS and RP. Further research should be conducted to look into the potential benefits of FT for localized PCa.