Table 2. List of studies assessing patient selection for FT.
| Author (ref) | Year | Aspect investigated | Key findings | Key recommendations |
|---|---|---|---|---|
| Priester et al. (8) | 2017 | Efficacy of mpMRI in describing index lesion | mpMRI correctly identifies index lesion in approximately 80% csPCa; mpMRI consistently underestimates index lesion size by 10 mm | When designing FT probe placement, extend margins by 10 mm to ensure complete lesion targeting |
| Ahmed et al. (15) | 2012 | To assess targeting of cancer areas with a margin of normal tissue across all PCa-risk categories | FT of individual prostate cancer lesions, whether multifocal or unifocal, leads to a low rate of genitourinary side-effects and an encouraging rate of early absence of clinically significant prostate cancer | Prioritization and support of a pragmatic, randomized, clinical trial comparing focal therapy with whole-gland treatments is urgently needed |
| Nassiri et al. (16) | 2018 | Refining the impact of patient selection criteria on FT eligibility | Eligibility determined by fusion biopsy was concordant with whole mount histology in 75% of cases. Using intermediate risk eligibility criteria, more than a third of men with a TBx proven lesion identified on mpMRI imaging would have been eligible for focal therapy | Correctly identifying ideal FT candidates allows to extend the treatment to include intermediate-risk patients |
| Oishi et al. (10) | 2019 | Oncological outcomes after FT at 5 years based on D’Amico risk group | Higher baseline PSA independently predicted treatment failure, biochemical failure, recurrence and radical treatment. Grade Group 3 or greater independently predicted treatment failure (P=0.04) | Due to the elevated risk treatment failure, FT should not be proposed to patient with High risk PCa |
| Sorce et al. (18) | 2021 | Assessing the relationship between the volume of the IL measured at mpMRI and at RP, stratifying it according to PI-RADS score | mpMRI significantly underestimated the exact volume of the IL, especially for small visible lesions, regardless of PI-RADS score | Consider these findings when planning tailored focal therapy approaches, especially if delivered to men harbouring smaller prostatic lesions |
| Le Nobin et al. (19) | 2015 | Comparing prostate tumor boundaries on mpMRI and RP histological assessment to define an optimal treatment margin for achieving complete tumor destruction | mpMRI underestimates histologically determined tumor boundaries, especially for lesions with a high imaging suspicion score and a high Gleason score | A 9 mm treatment margin around a lesion visible on magnetic resonance imaging would consistently ensure treatment of the entire histological tumor volume during focal ablative therapy |
csPCa, clinically significant prostate cancer; FT, Focal Therapy; IL, Index Lesion; mpMRI, multiparametric magnetic resonance imaging; PCa, prostate cancer; PI-RADS, Prostate Imaging-Reporting and Data System; RP, radical prostatectomy; TBx, targeted biopsy; PSA, prostate-specific antigen.