The Story of Breast and Prostate Cancer: Parallels and Common Controversies

The aim of this chapter is to provide a history of the introduction of focal therapy (FT) for breast and prostate cancer (BCa; PCa) and to review common barriers to implementation. The introduction of FT BCa began with a small retrospective case series. A better understanding of the biology behind tumor progression and well-designed randomized trials, as well as advances in screening and imaging, has led to the adoption of FT in the majority of patients with newly diagnosed BCa. The adoption of FT in PCa is now limited due to short-term oncologic follow-up and the need for more randomized clinical trials. Common criticisms of the adoption of FT for BCa and PCa have included historical views of Halstedian tumor biology, tumor multifocality, limitations of imaging, and the lack of randomized clinical trials. As with BCa in previous decades, long-term oncologic outcomes are needed to ensure the future of FT in PCa. Urologists should learn from the breast cancer evolution and surgical oncologist colleagues the paramount importance of a multidisciplinary approach to achieve satisfactory oncologic outcomes while maintaining optimal quality of life in patients with intermediate-risk PCa.