Focal Therapy of Prostate Cancer

Nicolai Hübner; Shahrokh F. Shariat; Mesut Remzi


Curr Opin Urol. 2018;28(6):550-554. 

In This Article

Diagnosis and Patient Selection

When considering a patient for focal therapy proper diagnostics is the key to success. The advantages of using of MRI and MRI-guided biopsy has been proven many times,[2,3] and becomes even more important in the context of focal therapy. As a visible lesion is necessary for true focal treatment (not including hemi-ablation), undergoing MRI is almost mandatory. Patients should then undergo MRI-guided biopsy to verify the index lesion as clinically significant cancer. A consensus meeting consisting of experts on focal therapy concluded that patients with a prostate-specific antigen of 15 ng/ml or less, clinical stage T1c-T2a, Gleason score 3+3 or 3+4 (ISUP 1 and 2) and a life expectancy of more than 10 years should be offered focal therapy as part of a trial.[4]

The presence of a multifocal tumour has been shown to not be an absolute contraindication for focal therapy, as tumour spread is believed to be caused by one dominant index lesion.[5,6] In a prospective trial, the outcomes of ablation of the index lesion using high-intensity focussed ultrasound (HIFU) were evaluated. Pad-free incontinence, erections sufficient for intercourse were preserved in 92.0 and 76.9% of patients, respectively. Negative biopsies for clinically significant cancer were obtained in 85.7% of patients at 12 months (48/56), and only 3.6% had clinically significant cancer at rebiopsy in untreated area, which was not detected at baseline.[7]