Focal therapy (FT) is a promising alternative with curative intent for Low- to Intermediate-risk localized Prostate Cancer (PCa), claiming better functional outcomes and safety profile than standard whole-gland treatments. Ten different FT modalities have been described in the literature. The objective of our narrative review is to evaluate the safety profile and functional outcomes of these different modalities and the current most used tools of assessment for those outcomes.
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 functional outcomes were included.
One-hundred-seven studies, reporting data on 6933 patients, were included (26 on High Intensity Focal Ultrasound, 22 on Focal Cryotherapy, 14 on Irreversible Electroporation, 11 on Focal brachytherapy, 10 on Focal Laser Ablation, 8 on Photodynamic Therapy, 3 on Microwave ablation, 3 on Robotic Partial Prostatectomy, 2 on bipolar Radio Frequency Ablation, 1 on Prostatic Artery Embolization, and 7 studies comparing different FTs). Post-operative pad-free rate ranged between 92.3-100%. Greater heterogeneity exists considering the Change in Erectile Function, with Changing in Erectile function- rates ranging between 0-94.4% (Cryotherapy). The most used Patient-Reported Outcome Measures (PROMs) were the International Prostate Symptom Score and the International Index of Erectile Function for incontinence/urinary function and potency, respectively. The most common reported complications were hematuria, infections, and urethral strictures, with rates widely ranging among different treatments. The Clavien-Dindo Classification was the most used (40/88 papers) to describe adverse events.
FT is a promising treatment for localized PCa, achieving excellent results in terms of safety and functional outcomes. There is a wide heterogeneity in the definition of PROMS and time of collection between studies. High quality comparative studies with standard treatments are needed to reinforce these findings.
Prostate cancer and prostatic diseases. 2023 Jul 25 [Epub ahead of print]
Rossella Nicoletti, Andrea Alberti, Daniele Castellani, Chi Hang Yee, Kai Zhang, Darren M C Poon, Peter Ka-Fung Chiu, Riccardo Campi, Giulio Raffaele Resta, Edoardo Dibilio, Giacomo Maria Pirola, Giuseppe Chiacchio, Demetra Fuligni, Carlo Brocca, Carlo Giulioni, Virgilio De Stefano, Sergio Serni, Vineet Gauhar, Chi Fai Ng, Mauro Gacci, Jeremy Yuen Chun Teoh
Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy., Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, Beijing United Family Hospital and Clinics, 100015, Beijing, China., Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong, China., Urology Unit, San Giuseppe Hospital, Multimedica Group, Milan, Italy., Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy., Ng Teng Fong General Hospital (NUHS), Singapore, Singapore., S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. .