The Horizon: Future of Focal Therapy in Prostate Cancer

Focal therapy is an image-guided ablation of an image-defined, biopsy-confirmed, cancerous area with a safety margin surrounding the targeted lesion(s). Abundant studies using different energies and techniques have shown that focal therapy in well-selected patients is safe and effective. Despite that, it still has a considerable margin for improvement. The development of new biomarkers beyond PSA, high-resolution imaging such as ultra-high-field MRI and PSMA PET, and artificial intelligence algorithms could revolutionize all the steps of focal therapy, especially the patient selection process and treatment planning and delivery. At the same time, the improvement of available technologies including high-precision fusion systems and segmentation software, and the widespread adoption of well-structured focal therapy programs could further improve its outcomes and offer a tailored treatment option for patients. Finally, posttreatment surveillance, by reducing the number of visits and exams, could become less invasive and more patient-friendly, with a positive impact on the patient’s quality of life. Investing time and resources in these promising tools has the potential to lead focal therapy to emerge as the new standard of care for suitable patients, and the next generation of urologists should seize this opportunity.