Table 1.

Pros and cons of focal therapies currently available for prostate cancer.

Treatment	Summary of Pros	Summary of Cons
High-intensity focused ultrasound	(i) Transrectal application negates the need for surgical approach (ii) Improvements in MRI technology allow real-time procedure monitoring and improved targeting	(i) Difficulty treating enlarged prostates, especially in overweight patients (ii) Effective treatment of anterior tumours is not achievable
Photodynamic therapy	(i) More selective than other focal therapies due to conditions needed for SDO production (ii) Can be applied at the same treatment site multiple times	Photosensitizing agent remains in patient's bloodstream following treatment, requiring protection of the eyes and skin for potentially weeks after the procedure
Cryotherapy	(i) Double freeze-thaw cycle effectively destroys cells in targeted region (ii) Can be applied as a salvage following radiotherapy techniques	(i) Urinary infections and perineal discomfort posttreatment are common (ii) Relatively invasive treatment, with added needed for thermal protection of urethra, bladder and rectum
Radiotherapy	(i) Minimally invasive approach as radiation is usually applied externally (ii) Proton beam therapy and Cyberknife technologies give hope of improved targeting with fewer side effects	(i) Many side effects as a result of radiation at unintended sites, causing urinary incontinence, rectal pain, and erectile dysfunction (ii) A third of patients experience radiorecurrent disease
Brachytherapy	Image guided seed placement allows effective treatment of localized areas	Needle array application is a highly invasive process