Focal Therapy for Prostate Cancer: Complications and Their Treatment

TY - JOUR

T1 - Focal Therapy for Prostate Cancer: Complications and Their Treatment

AU - Rakauskas, Arnas

AU - Marra, Giancarlo

AU - Heidegger, Isabel

AU - Kasivisvanathan, Veeru

AU - Kretschmer, Alexander

AU - Zattoni, Fabio

AU - Preisser, Felix

AU - Tilki, Derya

AU - Tsaur, Igor

AU - van den Bergh, Roderick

AU - Kesch, Claudia

AU - Ceci, Francesco

AU - Fankhauser, Christian

AU - Gandaglia, Giorgio

AU - Valerio, Massimo

N1 - Copyright © 2021 Rakauskas, Marra, Heidegger, Kasivisvanathan, Kretschmer, Zattoni, Preisser, Tilki, Tsaur, van den Bergh, Kesch, Ceci, Fankhauser, Gandaglia and Valerio.

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

U2 - 10.3389/fsurg.2021.696242

DO - 10.3389/fsurg.2021.696242

M3 - SCORING: Review article

C2 - 34322516

VL - 8

JO - FRONT SURG

JF - FRONT SURG

SN - 2296-875X

M1 - 696242

ER -