Assessment after focal therapy: what is the latest?

• Published in: Current opinion in urology Vol. 32; no. 3; p. 260
• Main Authors: Kotamarti, Srinath, Séguier, Denis, Arcot, Rohith, Polascik, Thomas J
• Format: Journal Article
• Language: English
• Published: United States 01.05.2022
• ISSN: 1473-6586
• DOI: 10.1097/MOU.0000000000000988

To review assessment after focal therapy (FT) in the context of developments from the past two years. With a paucity of high-quality studies, recent findings are primarily reliant on results from institutional-based cohorts and reports of expert consensus. Notably, oncologic treatment failure should be further stratified into recurrence in the in-field or out-of-field ablation zone, and both regions should be surveilled postoperatively. Monitoring primarily consists of periodic evaluations of prostate-specific antigen (PSA) testing and magnetic resonance imaging, with histologic sampling needed to confirm suspicion of recurrence. Recent investigations into PSA derivatives, contrast-enhanced ultrasound, and prostate-specific membrane antigen imaging have shown preliminary promise. Although postablation functional outcomes are generally accepted to be excellent, they are limited by the wide range of patient-reported measures, variability in individual practice, and low questionnaire completion rates. There is still a need for high-level, long-term data to inform exact standardized protocols to manage patients after FT. A multifaceted approach is required to surveil patients and identify those at risk of recurrence. Embracing shared responsibility between the patient and clinician to fastidiously monitor the infield and out-of-field ablation zones postoperatively is critical to maximize oncologic outcomes.