Table 2:

Summary of consensus statements

Role and rationale of focal therapy

- There is a role for focal therapy in select men discontinuing active surveillance.

- Compared to radical whole gland treatment, Focal therapy:

1. Is less invasive

2. Has greater likelihood to preserve erectile function

3. Has greater likelihood to preserve urinary continence

4. Is associated with earlier recovery post-treatment

Patient demographics and disease factors

- For age 60 – 80, should consider focal therapy when coming off active surveillance.

- Gleason 3+4 cancer (grade group 2) with localized disease

- Men with PSA <10 ng/mL are ideally suited for focal therapy

- Patients with multi-focal grade group 2 or higher lesions are not ideal candidates for focal therapy.

Work up

- An increasing PSA or a biomarker test indicating higher risk of adverse pathology should not prompt focal therapy, but instead prompt re-interrogation of the prostate.

- mpMRI/US guided fusion biopsy and a 12-core systematic biopsy is recommended for men on active surveillance prior to considering focal therapy.

- If unable to undergo mpMRI, patients will require a 3D mapping biopsy of the prostate to determine if they are a candidate for focal therapy

- No metastatic workup is usually required prior to considering focal therapy

Ablation template

- There was no consensus on the ideal template for focal therapy.

PSA: Prostate-specific antigen; mpMRI: multiparametric magnetic resonance imaging