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.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Lebastchi AH, Gill IS, Abreu AL. A Focus on Focal Therapy for Prostate Cancer. JAMA Surg. 2021;156(9):881–882. doi:10.1001/jamasurg.2021.3181
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: