Focal Therapy is an Option for the Majority of Localised Prostate Cancers: A Histopathological Study of Contemporary UK Radical Prostatectomies

Abstract

Objectives: Focal therapy for prostate cancer offers a management option intermediate between active surveillance and radical therapy for small volume, low grade localised prostate cancer. We studied a series of UK radical prostatectomies (RP) performed for organ-confined prostate cancer to identify the proportion of cases potentially suitable for pure lesion only focal therapy (PLFT) or focal hemi-gland ablation (FHA). Methods: The pathological features of 309 RP specimens were studied. Patients were grouped into the following categories: group A: unifocal cancer; group B: multifocal disease where only the index cancer was significant (Epstein's criteria); group C: unilateral multifocal significant disease; group D: bilateral multifocal significant disease. Results: 56% (172) patients were candidates for PLFT, including 70 group A cases plus 102 group B cases. Group C comprised 4% (11) cases who are candidates for FHA. Thus 60% (183) cases were candidates for either PLFT or FHA. Conclusions: A significant number of patients are potential candidates for focal therapy in this RP series. We encourage prospective clinical trials investigating the oncological safety and outcomes of focal therapy in treating low and intermediate risk localised prostate cancer.