Despite the evidence supporting the use of focal therapy (FT) in patients with localized prostate cancer (PCa), considerable variability exists in the patient selection criteria across current studies. This study aims to review the most recent evidence concerning the optimal approach to patient selection for FT in PCa.
PubMed database was systematically queried for studies reporting patient selection criteria in FT for PCa before December 31, 2023. After excluding non-relevant articles and a quality assessment, data were extracted, and results were described qualitatively.
There is no level I evidence regarding the best patient selection approach for FT in patients with PCa. Current international multidisciplinary consensus statements recommend multiparametric magnetic resonance imaging (mpMRI) followed by MRI-targeted and systematic biopsy for all candidates. FT may be considered in clinically localized, intermediate risk (Gleason 3 + 4 and 4 + 3), and preferably unifocal disease. Patients should have an acceptable life expectancy. Those with prostate volume >50 ml and erectile dysfunction should not be excluded from FT. Prostate-specific antigen (PSA) level of < 20 (ideally < 10) ng/mL is recommended. However, the utility of other molecular and genomic biomarkers in patient selection for FT remains unknown.
FT may be considered in well-selected patients with localized PCa. This review provides a comprehensive insight regarding the optimal approach for patient selection in FT.
Prostate cancer and prostatic diseases. 2024 Oct 23 [Epub ahead of print]
Alireza Ghoreifi, Leonard Gomella, Jim C Hu, Badrinath Konety, Luca Lunelli, Ardeshir R Rastinehad, Georg Salomon, Samir Taneja, Rafael Tourinho-Barbosa, Amir H Lebastchi
Department of Urology, University of Southern California, Los Angeles, CA, USA., Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA., Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA., Allina Health Cancer Institute, Minneapolis, Minneapolis, MN, USA., Department of Urology, Hospital Louis Pasteur, Chartres, France., The Smith Institute for Urology at Lenox Hill, New York, NY, USA., Martini Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, NYU Langone Health, New York, NY, USA., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France., Department of Urology, University of Southern California, Los Angeles, CA, USA. .