Focal Therapy for Prostate Cancer: Complications and Their Treatment

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.

Transperineal Targeted Microwave Ablation (TMA) of localized prostate cancer guided by MRI-Ultrasound fusion and organ-based tracking: a pilot study

“…[5,6] Therefore, focal therapy is de nitely an option for well-selected patients with strong desire for preservation of continence and sexual function. [7] Targeted microwave ablation and EORTC QLQ-C30 were assessed at baseline and at 1 month, 3 months, 6 months and 12 months after TMA. Uro owmetry was performed at baseline and at 1 month, 6 months and 12 months after TMA.…”

Effects of Curcumin and Lactoferrin to Inhibit the Growth and Migration of Prostatic Cancer Cells

“…To date, prostate cancer treatments have been evaluated through the introduction of targeted and inhibitory therapies toward specific androgen receptors [ 30 ]. However, patients show a highly variable response to these therapies, with the concomitant development of drug resistance [ 31 ] and the presence of side effects [ 32 ]. Much of the interest is aimed at discovering alternative or adjuvant treatments to improve the state of patients suffering from prostate cancer.…”

Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors

“…While generally safe, there are several risks of ablation of the prostate. Most complications typically occur within the first month of ablation and include hematuria, urinary tract infection, pain and discomfort, erectile dysfunction, dysuria, and urethral sloughing [ 168 ]. Recto-urethral fistula is a potential complication but a rare one and most often occurs when focal therapy is administered in a salvage setting and when the tumor is in the posterior portion of the prostate with extracapsular extension [ 168 ].…”