A Systematic Review of Focal Ablative Therapy for Clinically Localised Prostate Cancer in Comparison with Standard Management Options: Limitations of the Available Evidence and Recommendations for Clinical Practice and Further Research

Bates, Anthony; Ayers, Jennifer; Κωστακόπουλος, Νικόλαος; Lumsden, Thomas; Schoots, Ivo G.; Willemse, Peter‐Paul M.; Yuan, Yuhong; Bergh, Roderick C.N. van den; Grummet, Jeremy; Poel, Henk G. van der; Rouvière, Olivier; Moris, Lisa; Cumberbatch, Marcus; Lardas, Michael; Liew, Matthew; Broeck, Thomas Van den; Gandaglia, Giorgio; Fossati, Nicola; Briers, Erik; Santis, Maria De; Fanti, Stefano; Gillessen, Silke; Oprea-Lager, Daniela E.; Ploussard, Guillaume; Henry, Ann; Tilki, Derya; Wiegel, Thomas; N’Dow, James; Mason, Malcolm David; Cornford, Philip; Mottet, Nicolas; Lam, Thomas

doi:10.1016/j.euo.2020.12.008

Cited by 33 publications

(25 citation statements)

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“…performed a systematic review to evaluate the evidence for FT as a treatment strategy in comparison with the standard treatment options for clinically localized PCa. [ 33 ] They included five comparative studies (1 randomized clinical trial and 4 retrospective nonrandomized clinical studies) and ten systematic reviews. Majority of the systematic reviews included were heterogeneous studies with low patient numbers, most were uncontrolled single-arm case series, with no data on long-term outcomes and with significant limitations.…”

Section: Comparison With Standard Treatment Optionsmentioning

confidence: 99%

Focal therapy for localized prostate cancer – Current status

et al. 2022

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Section: Comparison With Standard Treatment Optionsmentioning

confidence: 99%

Focal therapy for localized prostate cancer – Current status

et al. 2022

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“…However, most of the studies had a retrospective design, a short follow-up time and a certain heterogeneity in defining outcome measures. A more recent systematic review including only comparative studies evaluating focal therapy against any standard treatment strategy has highlighted the lack of robust explanatory trials in the target population—men with clinically significant disease ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Focal Therapy for Prostate Cancer: Complications and Their Treatment

et al. 2021

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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.

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“…Focal therapy (FT) technology is rapidly developing, and the approach of selectively targeting index lesion(s) or part(s) of the prostate seeks to find the sweet spot of oncologic control while limiting side effects. In this context of innovation, Bates et al [3] provide a timely systematic review of the clinical effectiveness of FT for localized PCa in this issue of European Urology Oncology.…”

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“…Despite the availability of FT techniques for PCa ablation for many years, FT has remained outside the mainstream for a number of reasons. Bates et al [3] highlight several challenges in the field of FT.…”

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“…A number of studies that readers would have anticipated to be included in the review can be found in a supplementary table that illustrates reasons for noninclusion (the most common reason being <50 patients per treatment arm). Regardless of how one feels about the appropriate composition of studies to be evaluated in a systematic review, the work by Bates et al [3] demonstrates the limitation of high-level evidence around FT for localized PCa. The reality is that there is not much device manufacturer funding for clinical trials, in contrast to pharmaceutical therapies.…”

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