Focal Therapy and Active Surveillance of Prostate Cancer in East and South-East Asia

Active surveillance (AS) is the preferred management option for low-risk, low-grade prostate cancer (PCa) in the European Association of Urology (EAU) and American Urological Association (AUA) guidelines. The uptake of using AS for eligible men has significantly increased in the past decade in the Caucasian population, but the practice of AS in Asia is still uncommon and widely variable due to various barriers, including patients’ demand for treatment, refusal of repeated prostate biopsies on AS protocols, and physicians’ reimbursement patterns. The increasing use of prostate-specific antigen (PSA) and the rapid increase in the incidence of PCa in Asia have brought about large numbers of low-risk PCa, and this is an emerging problem that needs to be tackled. Focal therapy (FT) involving partial or whole gland energy ablation with HIFU or cryotherapy of the prostate to treat localized PCa has emerged as an alternative to radical treatments in Asia. The use of FT is associated with significantly lower morbidities compared with radical treatments and is an attractive option for patients. The use of FT in Asia is still in its early stages, and evidence is still limited, but its use is expected to increase in the years to come.