Abstract
Focal therapy is a modern alternative to selectively treat a specific part of the prostate harboring clinically significant disease while preserving the rest of the gland. The aim of this therapeutic approach is to retain the oncological benefit of active treatment and to minimize the side-effects of common radical treatments. The oncological effectiveness of focal therapy is yet to be proven in long-term robust trials. In contrast, the toxicity profile is well-established in randomized controlled trials and multiple robust prospective cohort studies. This narrative review summarizes the relevant evidence on complications and their management after focal therapy. When compared to whole gland treatments, focal therapy provides a substantial benefit in terms of adverse events reduction and preservation of genito-urinary function. The most common complications occur in the peri-operative period. Urinary tract infection and acute urinary retention can occur in up to 17% of patients, while dysuria and haematuria are more common. Urinary incontinence following focal therapy is very rare (0–5%), and the vast majority of patients recover in few weeks. Erectile dysfunction can occur after focal therapy in 0–46%: the baseline function and the ablation template are the most important factors predicting post-operative erectile dysfunction. Focal therapy in the salvage setting after external beam radiotherapy has a significantly higher rate of complications. Up to one man in 10 will present a severe complication.
Highlights
Prostate cancer is the second most commonly diagnosed cancer in men
Large prostates might not be suitable for some energy sources or treatment templates; in such cases, patients are more at risk to develop significant lower urinary tract symptoms (LUTS) after treatment
Patient sexual and urinary functions should be well-documented with validated patient-reported outcome measures (PROMs) prior to focal therapy
Summary
Prostate cancer is the second most commonly diagnosed cancer in men. Almost 1.3 million patients are diagnosed worldwide annually, and 360,000 deaths were related to prostate cancer in 2018 (3.8% of all deaths caused by cancer in men) [1]. The prevalence of prostate cancer increases with age; screening is generally recommended in well-informed men with prolonged life expectancy. The incidence of prostate cancer diagnosis varies widely between different geographical areas, largely due to different habits in screening policies by mean of prostate-specific antigen (PSA) testing, and life expectancy [2]. Decision making in men with localized disease is driven by risk classification, patient’s comorbidities and preferences. Men with low-risk disease are usually offered active surveillance whereas men with intermediate to high-risk disease are offered radical treatment in the form of surgery or radiation therapy
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