Focal Therapy for Prostate Cancer: An Evidence-Based Approach to Tissue-Preserving Strategies

The traditional approach of radical surgical extirpation for the treatment of prostate cancer (PCa) has evolved into a complex milieu of therapeutic options. Current research supports the concept of the index lesion as the biologic driving force responsible for PCa biology and risk for progression in an individual patient. With increasing accuracy and use of multiparametric MRI, in conjunction with targeted and fusion biopsies, to screen for and detect prostate cancer, our ability to localize the index lesion or PCa-containing lesions has substantially improved. This, in combination with a desire to offer oncologic treatment while preserving functional outcomes, has led to the development of a host of therapies collectively referred to as “focal therapy,” that is, targeted tissue ablation aimed at PCa-containing lesions while sparing the remainder of the prostate gland. Herein we review the literature on several of the modalities used for focal ablation of prostate cancer.