Reviewing focal therapies for patients with localized prostate cancer.

This article reviewed new studies on focal therapy (FT) in patients with localized prostate cancer (PCa), with a focus on treatment effectiveness. 

FT includes alternative, non-invasive methods for treating PCa. High-intensity focused ultrasound (HIFU) is a radiation-free technique that uses high-frequency ultrasound waves. Irreversible electroporation (IRE), also known as NanoKnife®, destroys tumor cells by the passage of an electrical current. Cryoablation involves freezing the whole prostate gland while focal laser ablation (FLA) uses heat to target cancer cells.

Focal brachytherapy (BT) places a radioactive source directly into the tumor. Photodynamic therapy (PDT) delivers a drug using a vein for killing cancer cells. Radiofrequency ablation (RFA) uses heat generated from an electrical current to remove prostate tissue. Prostatic artery embolization (PAE) involves restricting the blood flow to certain parts of the prostate, causing size reduction.

Recent advances in our knowledge of the safety and effectiveness of FTs are unknown and an updated review is needed.

This study reviewed data from 5827 patients in 72 other studies based on the delivery of FT using 8 different sources of energy. Of the 72 studies, 27 studies reported on HIFU, 9 studies on IRE, 11 studies on cryoablation, 8 studies on focal ablation and BT, 7 studies on PDT, 2 studies on RFA, and 1 study on PAE. 

For HIFU studies, an average of 95% of patients did not require urinary incontinence (leakage) pads, and an average of 85% of patients had no significant cancer in the treated area. For IRE, 92-100% of patients were pad-free. However, there was a significant decrease in erectile function. 

For PDT studies, there were no reported changes in incontinence and an average of 90% of patients did not have CSC.

For the other treatments, there were few patients included for a proper analysis. 

This article reviewed  FTs for localized PCa conducted over the past 5 years and found that the majority of studies were in an early research stage.

The study showed that HIFU and PDT had the most promise for advancement but more studies are needed.