Focal therapy for (recurrent) prostate cancer. Treat the lesion, preserve the man?

Abstract

The current thesis describes the role of focal therapy for localized prostate cancer in two settings: the primary treatment setting and the salvage treatment setting. Besides a general outline, the use of high-dose-rate brachytherapy as a focal treatment modality is explored specifically. Focal therapy is an organ-sparing alternative to conventional radical treatments with the primary aim of reducing treatment-related toxicity. In terms of toxicity and patient-reported quality of life, the results of focal high-dose-rate brachytherapy are promising, with a very limited effect on urinary and bowel function. However, in terms of tumor control, the results of primary focal high-dose-rate brachytherapy seem suboptimal as compared to oncologic outcomes of conventional radical radiotherapy or prostatectomy. Awaiting long-term oncological effectiveness data, primary focal therapy now seems most suitable to men who place greater value on maintaining genitourinary function than certainty over long‐term disease control. In the recurrent disease setting after primary whole-gland radiotherapy, there are fewer local re-treatment options due to an increased toxicity risk. Here, focal salvage treatments have emerged as a promising alternative, especially with the other treatment option being hormonal therapy. For the future, one of the biggest challenges will be to further optimize oncologic outcomes of focal therapy.