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Surgical Innovation
July 28, 2021

A Focus on Focal Therapy for Prostate Cancer

Author Affiliations
  • 1USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, University of Southern California, Los Angeles
  • 2Center for Image-Guided and Focal Therapy for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles
JAMA Surg. 2021;156(9):881-882. doi:10.1001/jamasurg.2021.3181

Recent advancements in imaging technology and biopsy strategies have improved tumor localization and risk stratification for prostate cancer (PCa).1 Concurrently, growing evidence supports the indolent nature of most PCa cases.2 These developments have created the impetus for clinicians to explore more tailored treatment approaches for patients diagnosed with PCa. Patients often balk at the morbidity following traditional whole-gland treatment options (radical prostatectomy [RP], radiotherapy [XRT]), instead preferring active surveillance or watchful waiting. Focal therapy (FT) offers a middle ground between these extremes by precisely targeting only the cancer-bearing part of the gland while preserving the remainder of the prostate and its delicate surrounding structures. By doing so, FT can provide oncological efficacy similar to RP and XRT while considerably reducing or even eliminating functional morbidities, such as incontinence and erectile dysfunction. There are various forms of FT in use, including cryoablation (the oldest modality; Figure) and high-intensity focused ultrasound (HIFU). Each has unique indications, risks, and benefits and uses a different energy source for ablation. Transrectal energy transmission via HIFU better targets posterior lesions. While cryotherapy is applied via the transperineal approach and allows access to the entire prostate, it is avoided for tumors close to the rectum or urethra because of concerns of thermal spread.

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