Focal Therapy for Prostate Cancer: Complications and Their Treatment

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.

[1]  H. G. van der Poel,et al.  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. , 2021, European urology oncology.

[2]  M. Emberton,et al.  Detailing sexual outcomes after treatment of localised prostate cancer with focal therapy using various energy sources: protocol for a mixed-methods study , 2020, BMJ Open.

[3]  S. Raman,et al.  Predicting Pathologic Tumor Size in Prostate Cancer Based on Multiparametric Prostate MRI and Preoperative Findings. , 2020, The Journal of urology.

[4]  X. Cathelineau,et al.  Impact of Focal Versus Whole Gland Ablation for Prostate Cancer on Sexual Function and Urinary Continence. , 2020, The Journal of urology.

[5]  A. Sidana,et al.  Standardized Nomenclature and Surveillance Methodologies After Focal Therapy and Partial Gland Ablation for Localized Prostate Cancer: An International Multidisciplinary Consensus. , 2020, European urology.

[6]  J. von Hardenberg,et al.  Prospective Feasibility Study of Single-Shot Antibiotic Prophylaxis in Transrectal Focal Ablation of Prostate Cancer , 2020, Urologia Internationalis.

[7]  D. Eberli,et al.  Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer: Safety outcomes and complications. , 2020, Urologic oncology.

[8]  P. Royce,et al.  Survival and quality of life outcomes of high-intensity focused ultrasound treatment of localized prostate cancer , 2020, Prostate international.

[9]  H. Ahmed,et al.  A systematic review of salvage focal therapies for localised non-metastatic radiorecurrent prostate cancer , 2020, Translational andrology and urology.

[10]  Jiawei Shi,et al.  Radical prostatectomy versus brachytherapy for clinically localized prostate cancer on oncological and functional outcomes: a meta-analysis , 2020, Translational andrology and urology.

[11]  Run Wang,et al.  Ejaculatory and Orgasmic Dysfunction Following Prostate Cancer Therapy: Clinical Management , 2019, Medical sciences.

[12]  E. Barret,et al.  Comprehensive Evaluation of Focal Therapy Complications in Prostate Cancer: A Standardized Methodology. , 2019, Journal of endourology.

[13]  H. Ahmed,et al.  Early-Medium-Term Outcomes of Primary Focal Cryotherapy to Treat Nonmetastatic Clinically Significant Prostate Cancer from a Prospective Multicentre Registry. , 2019, European urology.

[14]  Prashanth Rawla,et al.  Epidemiology of Prostate Cancer , 2019, World journal of oncology.

[15]  Raj Persad,et al.  A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer , 2018, European urology.

[16]  F. Hamdy,et al.  Partial ablation versus radical prostatectomy in intermediate-risk prostate cancer: the PART feasibility RCT. , 2018, Health technology assessment.

[17]  M. Emberton Has tailored, tissue‐selective tumour ablation in men with prostate cancer come of age? , 2018, BJU international.

[18]  D. Margolis,et al.  MRI‐Targeted or Standard Biopsy for Prostate‐Cancer Diagnosis , 2018, The New England journal of medicine.

[19]  H. Ahmed,et al.  A comparison of time taken to return to baseline erectile function following focal and whole gland ablative therapies for localized prostate cancer: A systematic review. , 2017, Urologic oncology.

[20]  A. Ouzzane,et al.  Focal therapy as primary treatment for localized prostate cancer: definition, needs and future. , 2017, Future oncology.

[21]  Yipeng Hu,et al.  The PICTURE study: diagnostic accuracy of multiparametric MRI in men requiring a repeat prostate biopsy , 2017, British Journal of Cancer.

[22]  J. Coleman,et al.  Patient selection for prostate focal therapy in the era of active surveillance: an International Delphi Consensus Project , 2017, Prostate Cancer and Prostatic Diseases.

[23]  M. Parmar,et al.  Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confi rmatory study , 2018 .

[24]  Antonio Alcaraz,et al.  Padeliporfin vascular-targeted photodynamic therapy versus active surveillance in men with low-risk prostate cancer (CLIN1001 PCM301): an open-label, phase 3, randomised controlled trial. , 2017, The Lancet. Oncology.

[25]  Shyam Natarajan,et al.  Magnetic Resonance Imaging Underestimation of Prostate Cancer Geometry: Use of Patient Specific Molds to Correlate Images with Whole Mount Pathology , 2017, The Journal of urology.

[26]  E. Barret,et al.  Focal Therapy for Prostate Cancer: An "À la Carte" Approach. , 2016, European urology.

[27]  H. Ahmed,et al.  The Effects of Focal Therapy for Prostate Cancer on Sexual Function: A Combined Analysis of Three Prospective Trials. , 2016, European urology.

[28]  Henry Rusinek,et al.  Image Guided Focal Therapy for Magnetic Resonance Imaging Visible Prostate Cancer: Defining a 3-Dimensional Treatment Margin Based on Magnetic Resonance Imaging Histology Co-Registration Analysis. , 2015, The Journal of urology.

[29]  Ian A. Donaldson,et al.  Focal Therapy: Patients, Interventions, and Outcomes—A Report from a Consensus Meeting , 2015, European urology.

[30]  P. Han,et al.  Management of Catheter-Related Bladder Discomfort in Patients Who Underwent Elective Surgery. , 2014, Journal of endourology.

[31]  Brenda J. Crowe,et al.  Protocol for a mixed-methods study of supplemental oxygen in pulmonary fibrosis , 2014, BMC Pulmonary Medicine.

[32]  Nathan Lawrentschuk,et al.  The Role of Focal Therapy in the Management of Localised Prostate Cancer: A Systematic Review , 2014, European urology.

[33]  P. Pinto,et al.  Imaging modalities in focal therapy: patient selection, treatment guidance, and follow-up , 2014, Current opinion in urology.

[34]  J. Stanford,et al.  Long-term functional outcomes after treatment for localized prostate cancer. , 2013, The New England journal of medicine.

[35]  H. Ahmed,et al.  Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study , 2012, The Lancet. Oncology.

[36]  E. Mohammadi,et al.  Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence , 2017, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[37]  F. Schmidt Meta-Analysis , 2008 .

[38]  T. H. van der Kwast Re: Magnetic Resonance Imaging Underestimation of Prostate Cancer Geometry: Use of Patient-specific Molds to Correlate Images with Whole-mount Pathology. , 2018, European urology.

[39]  H. Ahmed,et al.  Focal Ablation Targeted to the Index Lesion in Multifocal Localised Prostate Cancer: a Prospective Development Study. , 2015, European urology.

[40]  H. Thomas On clinical management. , 2005, The Health service journal.

[41]  K. Shadan,et al.  Available online: , 2012 .