Focal therapy for prostate cancer: current evidence and controversies

Abstract

Focal therapy is an organ-preserving strategy for selected patients with localized prostate cancer, aiming to eradicate clinically significant disease while preserving uninvolved prostate tissue. Advances in multiparametric magnetic resonance imaging, targeted biopsy, and ablative technologies have improved patient selection and treatment planning. Contemporary studies report encouraging short- and intermediate-term oncological control with relatively low rates of major urinary and sexual morbidity. However, the available evidence remains limited by heterogeneity in patient selection, ablative technologies, definitions of treatment failure, and follow-up protocols. The lack of mature comparative trials against radical prostatectomy or radiotherapy remains a major limitation to its adoption as standard treatment. Focal therapy is a promising option for carefully selected patients, particularly those with localized favorable intermediate-risk disease. Nevertheless, current evidence does not establish long-term oncological equivalence with radical treatments. Standardization of patient selection, treatment delivery, and surveillance, together with adequately powered comparative studies and long-term follow-up, is required to define its definitive role in prostate cancer management.