Active surveillance and radical therapy in prostate cancer: can focal therapy offer the middle way?

INTRODUCTION: Focal therapy for prostate cancer is a radical paradigm shift in the management of men with localised prostate cancer. It involves locating and destroying only the areas of prostate cancer whilst leaving the majority of the prostate untreated. By doing so, it is proposed that side-effects of traditional whole-gland therapies such as impotence, incontinence and rectal toxicity will be significantly reduced and cancer control will be at similar levels.

METHODS AND MATERIALS: A Medline/Pubmed search was conducted between 1 May 1998 and 1 May 2008 using the following terms: 'focal therapy', 'lumpectomy', 'hemiablation', 'laterality', 'multifocal', 'unifocal' and 'index lesion' alongside 'prostate cancer'. Articles were selected for their relevance to this review. Abstracts from international conferences over the last 5 years were also used where appropriate. Authors' personal bibliography was used to supplement the review.

CONCLUSIONS: A number of case series have reported significantly lower incontinence and impotence rates using focal cryoablation and one series on focal HIFU. The reporting quality has been variable and there are currently ongoing clinical trials with IRB approval in the USA and UK. Long term follow-up is required. Focal therapy is an exciting new area of research that could hold great promise for men with localised low to intermediate risk prostate cancer.