Focal Minimally Invasive Treatment in Localized Prostate Cancer: Comprehensive Review of Different Possible Strategies

Abstract

Background: Focal therapy is a promising, minimally invasive method for the treatment of patients with localized prostate cancer. According to the existing literature, there is growing evidence for positive functional outcomes and oncological effectiveness. The aim of this review is to evaluate the technical efficacy of three minimally invasive techniques (cryoablation, electroporation, and microwave ablation) and their impact on quality of life in patients with prostate cancer. Methods: Studies between January 2020 and July 2023 were selected using PubMed, Embase, and The Cochrane Library and analyzed following PRISMA guidelines; they have not been registered. Results: Twenty-three studies investigating three different sources of energy to deliver focal therapy were found. Thirteen studies evaluated the performance of the cryoablation therapy, seven studies of the irreversible electroporation, and three studies of microwave ablation option. The majority of studies were retrospective cohort studies. Cryoablation showed excellent oncological outcomes for low-grade prostate cancer, whether performed on the lesion, on the hemigland, or on the entire gland, with the best results obtained for patients with intermediate risk. Irreversible electroporation showed promising oncological outcomes with no significant changes in functional outcomes. Microwave ablation showed great early functional outcomes. Conclusions: The oncological effectiveness of minimally invasive treatment in comparison to standard of care is still under investigation, despite encouraging results in terms of functional outcomes improvement and adverse events reduction. More comprehensive research is needed to fully understand the function of minimally invasive treatment in patients with localized PCa.

Treatment Planning Strategies for Interstitial Ultrasound Ablation of Prostate Cancer

“…With early diagnosis rates on the rise due to advanced screening methods (e.g., biopsy, MRI, PSA), treatment approaches have evolved to encompass a spectrum of options that balance disease control with minimizing treatment-related side effects. Among these approaches, focal therapy has emerged as a promising strategy that seeks to precisely target local cancerous areas within the prostate gland using forms of radiation therapy, targeted drugs, or thermal ablation, while minimizing collateral damage to surrounding healthy tissue and reducing the potential for adverse effects [5] , [6] , [7] . Thermal ablation [8] , [9] , [10] , [11] as a means of focal therapy has acquired substantial attention in recent years as clinical evidence continues to demonstrate its efficacy for prostate disease.…”