Could focal therapy in prostate cancer replace standard therapy in the future?

Prostate-specific antigen screening has led to a dramatically increased detection of small-volume, low grade and organ-confined prostate cancer. In an era where active surveillance is now considered a feasible alternative for low-risk prostate cancer patients, it is possible that organ-sparing treatments like focal treatments options (HIFU, CSAP vs.) could also be good treatment alternatives in selected patient groups. Focal therapy is an appealing strategy for any tumor and in time may prove to be a valuable treatment option for low-risk, carefully selected prostate cancer patients. The aim of focal therapy is to achieve long-term cancer control with minimal morbidity yet without the side effects of radical therapy. Appropriate selection techniques for focal therapy are developing. Diagnostic methods for focal therapy like extensive mapping prostate biopsies, imaging techniques, and biomarkers are obligatory to improve the efficacy of focal therapy. Limitations of focal therapy consist of the incapability to stage or grade the prostate cancer accurately, suboptimal diagnostic methods, uncertainty regarding the natural history of untreated cancer foci, difficulties in follow-up and the lack of comparison with other treatment strategies. Early experiences of focal therapy evaluating a variety of modalities are encouraging but hampered by study design limitations and small sample sizes. Focal therapy is an encouraging treatment alternative and in time may be proven to be a valuable treatment option for low-risk, carefully selected prostate cancer patients. Prospective clinical trials had to be done before the strategy of focal treatment is accepted in clinical practice.