Focal therapy for the treatment of localized prostate cancer: a potential therapeutic paradigm shift awaiting better imaging.

PURPOSE OF REVIEW: Prostate cancer is a complex disease entity that covers a wide prognosis spectrum. Prostate cancer treatment options do not match this spectrum well. Focal therapy is an active area of research that may allow us to better match treatment to prognosis across the prostate cancer spectrum.

RECENT FINDINGS: Modern technology now allows us to perform focal ablation of prostate cancer. However, important issues remain: uncertain patient selection criteria (anatomically solitary versus biologically solitary cancer lesion), evolving management protocols (inadequate intraprostatic imaging, imprecise targeting/delivery of destructive energy), and nonstandardized follow-up metrics and failure definitions. Nevertheless, patients are already being treated at academic and private practices, sometimes as part of Institutional Review Board-approved research, more often not.

SUMMARY: The potential of focal therapy in treatment of prostate cancer is undeniable. As better staging becomes possible, focal therapy will likely be offered to a considerable proportion of prostate cancer patients. Meticulous patient selection and follow-up, in the setting of well designed clinical studies and registries, will be necessary.