Rationale for Focal Therapy

Prostate cancer is the most frequently diagnosed male cancer, accounting for 10% of all male cancer deaths each year. There are a spectrum of therapies available for prostate cancer, with minimally invasive therapies such as active surveillance, also known as “watchful waiting,” and more invasive whole-gland therapies such as radiotherapy and radical prostatectomy. Active surveillance and whole-gland therapies each has its own drawbacks, including anxiety/uncertainty and incontinence/erectile dysfunction, respectively. With advances in prostate cancer imaging, localization, and targeting, it has become possible to specifically target and treat foci of prostate cancer while sparing the surrounding healthy tissue; this approach is known as focal therapy. This chapter aims to examine the rationale and conceptual basis behind focal therapy. Topics explored in this chapter include appropriate patient selection, treatment of the index/clinically significant lesion, accurate lesion localization and treatment delivery, functional outcomes following focal therapy, and cost-effectiveness of focal therapy versus whole-gland therapies.