SIU-ICUD: Focal Therapy for PCa — The Technique

<b>Background/Objectives:</b> Focal therapy (FT) and technology are closely connected. Advanced imaging allows for precise identification of the index lesion, enabling the targeted use of various thermal and non-thermal energy sources through different approaches, with specific technique...

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Main Authors: Lara Rodriguez-Sanchez, Thomas J. Polascik, Kara Watts, Peter Ka-Fung Chiu, Mark Emberton, Behfar Ehdaie, Hashim U. Ahmed, Andre Abreu, Ardeshir R. Rastinehad, Rafael Sanchez-Salas
Format: Article
Language:English
Published: MDPI AG 2025-06-01
Series:Société Internationale d’Urologie Journal
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Online Access:https://www.mdpi.com/2563-6499/6/3/38
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author Lara Rodriguez-Sanchez
Thomas J. Polascik
Kara Watts
Peter Ka-Fung Chiu
Mark Emberton
Behfar Ehdaie
Hashim U. Ahmed
Andre Abreu
Ardeshir R. Rastinehad
Rafael Sanchez-Salas
author_facet Lara Rodriguez-Sanchez
Thomas J. Polascik
Kara Watts
Peter Ka-Fung Chiu
Mark Emberton
Behfar Ehdaie
Hashim U. Ahmed
Andre Abreu
Ardeshir R. Rastinehad
Rafael Sanchez-Salas
author_sort Lara Rodriguez-Sanchez
collection DOAJ
description <b>Background/Objectives:</b> Focal therapy (FT) and technology are closely connected. Advanced imaging allows for precise identification of the index lesion, enabling the targeted use of various thermal and non-thermal energy sources through different approaches, with specific techniques tailored to lesion location and operator expertise. This personalized approach enhances both safety and effectiveness, facilitating customized treatment planning. <b>Methods:</b> The International Consultation on Urological Diseases formed a committee to review the current literature on FT for prostate cancer (PCa), focusing specifically on the technique. Following in-depth discussions, the committee chose a “by lesion” approach rather than the traditional “by energy” approach to structure the review. A comprehensive PubMed search was conducted to gather relevant articles on the various energy modalities and procedural approaches used in FT for PCa. <b>Results:</b> Lesions in the apex, anterior, and posterior regions of the prostate can be accessed through several FT approaches, each associated with specific energy modalities and techniques. The transrectal approach utilizes high-intensity focused ultrasound (HIFU) and focal laser ablation (FLA), while the transperineal approach is compatible with energy sources such as cryotherapy, irreversible electroporation (IRE), brachytherapy, and FLA. The transurethral approach supports methods such as transurethral ultrasound ablation (TULSA). Each approach offers distinct advantages based on lesion location, treatment area, and energy modality. The choice of technique evaluated the safety and efficacy of each energy source and approach based on specific treatment areas within the prostate, highlighting the need for robust research across lesion locations and modalities, rather than focusing solely on each modality for a specific region. <b>Conclusions:</b> FT is rapidly advancing with new energy sources, technological improvements, and increasing operator expertise. To further optimize FT, research should prioritize evaluating the safety and effectiveness of different energy sources for various lesion locations, focusing on the treatment area rather than the energy modality itself.
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spelling doaj-art-a0788c99d5fd46bd9af5731378bbb1af2025-08-20T03:29:44ZengMDPI AGSociété Internationale d’Urologie Journal2563-64992025-06-01633810.3390/siuj6030038SIU-ICUD: Focal Therapy for PCa — The TechniqueLara Rodriguez-Sanchez0Thomas J. Polascik1Kara Watts2Peter Ka-Fung Chiu3Mark Emberton4Behfar Ehdaie5Hashim U. Ahmed6Andre Abreu7Ardeshir R. Rastinehad8Rafael Sanchez-Salas9Department of Urology, Institut Mutualiste Montsouris, 75014 Paris, FranceDepartment of Urology, Duke Cancer Institute, Durham, NC 27710, USADepartment of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USASH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong 9990777, ChinaDivision of Surgery and Interventional Science, University College London, London WC1E 6BT, UKUrology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USAImperial Prostate, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, UKKeck Medical Center of USC, USC Institute of Urology, University of Southern California, Los Angeles, CA 90033, USANorthwell Health, Smith Institute for Urology at Lenox Hill Hospital, Lake Success, NY 11042, USADivision of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada<b>Background/Objectives:</b> Focal therapy (FT) and technology are closely connected. Advanced imaging allows for precise identification of the index lesion, enabling the targeted use of various thermal and non-thermal energy sources through different approaches, with specific techniques tailored to lesion location and operator expertise. This personalized approach enhances both safety and effectiveness, facilitating customized treatment planning. <b>Methods:</b> The International Consultation on Urological Diseases formed a committee to review the current literature on FT for prostate cancer (PCa), focusing specifically on the technique. Following in-depth discussions, the committee chose a “by lesion” approach rather than the traditional “by energy” approach to structure the review. A comprehensive PubMed search was conducted to gather relevant articles on the various energy modalities and procedural approaches used in FT for PCa. <b>Results:</b> Lesions in the apex, anterior, and posterior regions of the prostate can be accessed through several FT approaches, each associated with specific energy modalities and techniques. The transrectal approach utilizes high-intensity focused ultrasound (HIFU) and focal laser ablation (FLA), while the transperineal approach is compatible with energy sources such as cryotherapy, irreversible electroporation (IRE), brachytherapy, and FLA. The transurethral approach supports methods such as transurethral ultrasound ablation (TULSA). Each approach offers distinct advantages based on lesion location, treatment area, and energy modality. The choice of technique evaluated the safety and efficacy of each energy source and approach based on specific treatment areas within the prostate, highlighting the need for robust research across lesion locations and modalities, rather than focusing solely on each modality for a specific region. <b>Conclusions:</b> FT is rapidly advancing with new energy sources, technological improvements, and increasing operator expertise. To further optimize FT, research should prioritize evaluating the safety and effectiveness of different energy sources for various lesion locations, focusing on the treatment area rather than the energy modality itself.https://www.mdpi.com/2563-6499/6/3/38focal therapyprostate cancertechniqueenergy source
spellingShingle Lara Rodriguez-Sanchez
Thomas J. Polascik
Kara Watts
Peter Ka-Fung Chiu
Mark Emberton
Behfar Ehdaie
Hashim U. Ahmed
Andre Abreu
Ardeshir R. Rastinehad
Rafael Sanchez-Salas
SIU-ICUD: Focal Therapy for PCa — The Technique
Société Internationale d’Urologie Journal
focal therapy
prostate cancer
technique
energy source
title SIU-ICUD: Focal Therapy for PCa — The Technique
title_full SIU-ICUD: Focal Therapy for PCa — The Technique
title_fullStr SIU-ICUD: Focal Therapy for PCa — The Technique
title_full_unstemmed SIU-ICUD: Focal Therapy for PCa — The Technique
title_short SIU-ICUD: Focal Therapy for PCa — The Technique
title_sort siu icud focal therapy for pca the technique
topic focal therapy
prostate cancer
technique
energy source
url https://www.mdpi.com/2563-6499/6/3/38
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