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Word Count (text): 4,713Keywords: focal therapy, partial ablation, prostate cancer 2 ABSTRACT Context: focal therapy of prostate cancer has been proposed as an alternative to wholegland treatments.Objective: to summarise the evidence regarding sources of energy employed in focal therapy.Evidence Acquisition: Embase and Medline (PubMed) were searched from 1996 to 31 st October 2015 following the PRISMA statement. Ongoing trials were selected from electronic registries.Evidence Synthesis: thirty-seven articles reporting on 3,230 patients undergoing focal therapy were selected. 13 reported on high intensity focused ultrasound (HIFU), 11 on cryotherapy, three on photodynamic therapy (PDT), four on laser interstitial thermotherapy (LITT), two on brachytherapy, three on irreversible electroporation (IRE), and one on radiofrequency (RFA). HIFU, cryotherapy, PDT and brachytherapy have been assessed in up to stage 2b studies. LITT and IRE have been evaluated in up to stage 2a studies. RFA has been evaluated in one stage 1 study. Median follow-up varied between 4-61 months, and median rate of serious adverse events ranged between 0-10.6%. Pad-free leak-free continence and potency were obtained in 83.3-100% and 81.5-100%, respectively. In series with intentionto-treat, the median rate of significant and insignificant disease at control biopsy varied between 0-13.4% and 5.1-45.9%, respectively. Main limitations are the length of follow-up, the absence of a comparator arm, and study heterogeneity.Conclusion: focal therapy has been evaluated using seven sources of energy in single-arm retrospective and prospective development studies up to stage 2b. Focal therapy seems to 3 have minor impact on quality of life and genito-urinary function. Cancer-control is encouraging, although this needs to be verified in high quality comparative effectiveness studies.Patient summary: seven sources of energy have been employed to selectively ablate discrete areas of prostate cancer. There is high evidence that focal therapy is safe and has low detrimental impact on continence and potency. The oncological outcome has yet to be evaluated against standard of care.

Perioperative enteral IN decreases morbidity and hospital stay but not mortality after major gastrointestinal surgery; its routine use can be recommended.

Proper management of postoperative complications, such as pancreatic leak and intraabdominal abscess, minimizes the risk of delayed PPH. Sentinel bleeding needs to be thoroughly investigated. If a pseudoaneurysm is detected, it has to be treated by interventional angiography, in order to prevent a further delayed PPH. Early angiography and embolization or stenting is safe and should be the procedure of choice. Surgery remains a therapeutic option if no interventional radiology is available, or patients cannot be resuscitated for an interventional treatment.

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