Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Clinical

Surveillance after Focal Therapy – a Comprehensive Review

Prostate Cancer and Prostatic Diseases volume 28, pages 662–671 (2025)Cite this article

Subjects

Abstract

Background

to date, no standardized, evidence-based follow-up schemes exist for the monitoring of patients who underwent focal therapy (FT) and expert centers rely mainly on their own experience and/or institutional protocols. We aimed to perform a comprehensive review of the most advantageous follow-up strategies and their rationale after FT for prostate cancer (PCa).

Methods

a narrative review of the literature was conducted to investigate different follow-up protocols of FT for PCa. Outcomes of interest were post-ablation oncological and functional outcomes and complications.

Results

Oncological success after FT was generally defined as the biopsy-confirmed absence of clinically significant PCa in the treated zone. De novo PCa in the untreated area usually reflects an inaccurate patient selection and should be treated as primary PCa. During follow-up, oncological outcomes should be evaluated with periodic PSA, multiparametric MRI and prostate biopsy. The use of PSA derivatives and new biomarkers is still controversial and therefore not recommended. The first MRI after FT should be performed between 6-12 months to avoid ablation-related artifacts and diagnostic delay in case of FT failure. Other imaging modalities, such as PSMA PET/CT scan, are promising but still need to be validated in the post-FT setting. A 12-month “for-protocol” prostate biopsy, including targeted and systematic biopsy, was generally considered the preferred biopsy method to rule out tumor persistence/recurrence. Subsequent mpMRIs and biopsies should follow a risk-adapted approach depending on the clinical scenario. Functional outcomes should be periodically assessed using validated questionnaires within the first year, when typically recover to a new baseline. Complications, despite uncommon, should be strictly monitored mainly in the first month.

Conclusions

FT follow-up is a multifaceted process involving clinical, radiological, and histological assessment. Studies evaluating the impact of different follow-up strategies and ideal timings are needed to produce standardized protocols following FT.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Multiparametric MRI images showing a Gleason Grade 2 left mid-anterior transition zone lesion treated with focal laser ablation (FLA) without tumor recurrence.
Fig. 2: One-year post-ablation MRI changes using different energies.
Fig. 3: Multiparametric MRI images (T2-weighted [T2W] and T1-weighted [T1W]) showing 1-year tumor recurrence after HIFU right lobe hemiablation for a right posterior tumor.
Fig. 4: Prostate Imaging after Focal Ablation (PI-FAB) score and Transatlantic Recommendations for Prostate Gland Evaluation with Magnetic Resonance Imaging After Focal Therapy (TARGET) score.
Fig. 5: Multiparametric MRI and PSMA PET/CT showing recurrence 12 months after focal HIFU.

Similar content being viewed by others

References

  1. Shah TT, Peters M, Eldred-Evans D, Miah S, Yap T, Faure-Walker NA, et al. Early-medium-term outcomes of primary focal cryotherapy to treat nonmetastatic clinically significant prostate cancer from a prospective multicentre registry. Eur Urol. 2019;76:98–105.

    Article  PubMed  Google Scholar 

  2. Reddy D, Peters M, Shah TT, van Son M, Tanaka MB, Huber PM, et al. Cancer control outcomes following focal therapy using high-intensity focused ultrasound in 1379 men with nonmetastatic prostate cancer: a multi-institute 15-year experience. Eur Urol. 2022;81:407–13. https://doi.org/10.1016/j.eururo.2022.01.005.

    Article  PubMed  Google Scholar 

  3. Hamdy FC, Donovan JL, Lane JA, Metcalfe C, Davis M, Turner EL, et al. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N. Engl J Med. 2023;388:1547–58. https://doi.org/10.1056/NEJMoa2214122.

    Article  PubMed  Google Scholar 

  4. Connor MJ, Gorin MA, Ahmed HU, Nigam R. Focal therapy for localized prostate cancer in the era of routine multi-parametric MRI. Prostate Cancer Prostat Dis. 2020;23:232–43. https://doi.org/10.1038/s41391-020-0206-6.

    Article  CAS  Google Scholar 

  5. Tay KJ, Amin MB, Ghai S, Jimenez RE, Kench JG, Klotz L, et al. Surveillance after prostate focal therapy. World J Urol. 2019;37:397–407. https://doi.org/10.1007/s00345-018-2363-y.

    Article  PubMed  Google Scholar 

  6. Postema AW, De Reijke TM, Ukimura O, Van den Bos W, Azzouzi AR, Barret E, et al. Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project. World J Urol. 2016;34:1373–82. https://doi.org/10.1007/s00345-016-1782-x.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Lebastchi AH, George AK, Polascik TJ, Coleman J, de la Rosette J, Turkbey B, et al. Standardized nomenclature and surveillance methodologies after focal therapy and partial gland ablation for localized prostate cancer: an international multidisciplinary consensus. Eur Urol. 2020;78:371–8. https://doi.org/10.1016/j.eururo.2020.05.018.

    Article  PubMed  PubMed Central  Google Scholar 

  8. van den Bos W, Muller BG, Ahmed H, Bangma CH, Barret E, Crouzet S, et al. Focal therapy in prostate cancer: international multidisciplinary consensus on trial design. Eur Urol. 2014;65:1078–83. https://doi.org/10.1016/j.eururo.2014.01.001.

    Article  PubMed  Google Scholar 

  9. Mottet N, Cornford P, van den Bergh RCN, Briers E, Eberli D, De Meerleer G, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer 2023. Edn. presented at the EAU Annual Congress Milan 2023. ISBN 978-94-92671-19-6. Available from: https://uroweb.org/guidelines/prostate-cancer

  10. Eastham JA, Auffenberg GB, Barocas DA, Chou R, Crispino T, Davis JW, et al. Clinically localized prostate cancer: AUA/ASTRO guideline, part II: principles of active surveillance, principles of surgery, and follow-up. J Urol. 2022;208:19–25.

    Article  PubMed  Google Scholar 

  11. Donaldson IA, Alonzi R, Barratt D, Barret E, Berge V, Bott S, et al. Focal therapy: patients, interventions, and outcomes-a report from a consensus meeting. Eur Urol. 2015;67:771–7. https://doi.org/10.1016/j.eururo.2014.09.018.

    Article  PubMed  PubMed Central  Google Scholar 

  12. van Luijtelaar A, Greenwood BM, Ahmed HU, Barqawi AB, Barret E, Bomers JGR, et al. Focal laser ablation as clinical treatment of prostate cancer: report from a Delphi consensus project. World J Urol. 2019;37:2147–53. https://doi.org/10.1007/s00345-019-02636-7.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Marra G, Soeterik T, Oreggia D, Tourinho-Barbosa R, Moschini M, Filippini C, et al. Long-term Outcomes of Focal Cryotherapy for Low- to Intermediate-risk Prostate Cancer: Results and Matched Pair Analysis with Active Surveillance. Eur Urol Focus. 2022;8:701–9. https://doi.org/10.1016/j.euf.2021.04.008.

    Article  PubMed  Google Scholar 

  14. Kayano PP, Klotz L. Current evidence for focal therapy and partial gland ablation for organ-confined prostate cancer: systematic review of literature published in the last 2 years. Curr Opin Urol. 2021;31:49–57. https://doi.org/10.1097/MOU.0000000000000838.

    Article  PubMed  Google Scholar 

  15. Breda A, Anterasian C, Belldegrun A. Management and outcomes of tumor recurrence after focal ablation renal therapy. J Endourol. 2010;24:749–52. https://doi.org/10.1089/end.2009.0658.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Scheltema MJ, Geboers B, Blazevski A, Doan P, Katelaris A, Agrawal S, et al. Median 5-year outcomes of primary focal irreversible electroporation for localised prostate cancer. BJU Int. 2023;131:6–13. https://doi.org/10.1111/bju.15946.

    Article  PubMed  Google Scholar 

  17. Marconi L, Stonier T, Tourinho-Barbosa R, Moore C, Ahmed HU, Cathelineau X, et al. Robot-assisted radical prostatectomy after focal therapy: oncological, functional outcomes and predictors of recurrence. Eur Urol. 2019;76:27–30. https://doi.org/10.1016/j.eururo.2019.03.007.

    Article  PubMed  Google Scholar 

  18. Van Hemelrijck M, Ji X, Helleman J, Roobol MJ, van der Linden W, Nieboer D, et al. Reasons for discontinuing active surveillance: assessment of 21 centres in 12 countries in the Movember GAP3 Consortium. Eur Urol. 2019;75:523–31. https://doi.org/10.1016/j.eururo.2018.10.025.

    Article  PubMed  Google Scholar 

  19. Jansen BHE, van Leeuwen PJ, Wondergem M, van der Sluis TM, Nieuwenhuijzen JA, Knol RJJ, et al. Detection of recurrent prostate cancer using prostate-specific membrane antigen positron emission tomography in patients not meeting the Phoenix criteria for biochemical recurrence after curative radiotherapy. Eur Urol Oncol. 2021;4:821–5. https://doi.org/10.1016/j.euo.2020.01.002.

    Article  PubMed  Google Scholar 

  20. Tourinho-Barbosa RR, Wood BJ, Abreu AL, Nahar B, Shin T, Guven S, et al. Current state of image-guided focal therapy for prostate cancer. World J Urol. 2021;39:701–17. https://doi.org/10.1007/s00345-020-03254-4.

    Article  PubMed  Google Scholar 

  21. Andolfi C, Vickers AJ, Cooperberg MR, Carroll PR, Cowan JE, Paner GP, et al. Blood prostate-specific antigen by volume of benign, Gleason Pattern 3 and 4 Prostate tissue. Urology. 2022;170:154–60. https://doi.org/10.1016/j.urology.2022.08.014.

    Article  PubMed  Google Scholar 

  22. Kotamarti S, Séguier D, Arcot R, Polascik TJ. Assessment after focal therapy: what is the latest? Curr Opin Urol. 2022;32:260–6. https://doi.org/10.1097/MOU.0000000000000988.

    Article  PubMed  Google Scholar 

  23. Oishi M, Gill IS, Tafuri A, Shakir A, Cacciamani GE, Iwata T, et al. Hemigland cryoablation of localized low, intermediate and high risk prostate cancer: oncologic and functional outcomes at 5 years. J Urol. 2019;202:1188–98. https://doi.org/10.1097/JU.0000000000000456.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kongnyuy M, Islam S, Mbah AK, Halpern DM, Werneburg GT, Kosinski KE, et al. PSA kinetics following primary focal cryotherapy (hemiablation) in organ-confined prostate cancer patients. World J Urol. 2018;36:209–13. https://doi.org/10.1007/s00345-017-2130-5.

    Article  PubMed  CAS  Google Scholar 

  25. Stabile A, Orczyk C, Giganti F, Moschini M, Allen C, Punwani S, et al. The role of percentage of prostate-specific antigen reduction after focal therapy using high-intensity focused ultrasound for primary localised prostate cancer. results from a large multi-institutional series. Eur Urol. 2020;78:155–60. https://doi.org/10.1016/j.eururo.2020.04.068.

    Article  PubMed  CAS  Google Scholar 

  26. Huber PM, Afzal N, Arya M, Boxler S, Dudderidge T, Emberton M, et al. Prostate specific antigen criteria to diagnose failure of cancer control following focal therapy of nonmetastatic prostate cancer using high intensity focused ultrasound. J Urol. 2020;203:734–42. https://doi.org/10.1097/JU.0000000000000747.

    Article  PubMed  Google Scholar 

  27. Dickinson L, Ahmed HU, Hindley RG, McCartan N, Freeman A, Allen C, et al. Prostate-specific antigen vs. magnetic resonance imaging parameters for assessing oncological outcomes after high intensity-focused ultrasound focal therapy for localized prostate cancer. Urol Oncol. 2017;35:30.e9–30.e15. https://doi.org/10.1016/j.urolonc.2016.07.015.

    Article  PubMed  CAS  Google Scholar 

  28. Khandwala YS, Morisetty S, Ghanouni P, Fan RE, Soerensen SJC, Rusu M, et al. Evaluation of post-ablation mpMRI as a predictor of residual prostate cancer after focal high intensity focused ultrasound (HIFU) ablation. Urol Oncol. 2022;40:489.e9–489.e17. https://doi.org/10.1016/j.urolonc.2022.07.017.

    Article  PubMed  Google Scholar 

  29. Elshafei A, Tay KJ, Kara O, Malkoc E, Nyame Y, Arora H, et al. Associations between prostate volume and oncologic outcomes in men undergoing focal cryoablation of the prostate. Clin Genitourin Cancer. 2018;16:e477–e482. https://doi.org/10.1016/j.clgc.2017.10.009.

    Article  PubMed  Google Scholar 

  30. Marra G, Laguna MP, Walz J, Pavlovich CP, Bianco F, Gregg J, et al. Molecular biomarkers in the context of focal therapy for prostate cancer: recommendations of a Delphi Consensus from the Focal Therapy Society. Minerva Urol Nephrol. 2022;74:581–9. https://doi.org/10.23736/S2724-6051.20.04160-0.

    Article  PubMed  Google Scholar 

  31. Deivasigamani S, Polascik TJ. Personal communication, currently under peer review. May 15, 2024.

  32. Ghafoor S, Becker AS, Stocker D, Barth BK, Eberli D, Donati OF, et al. Magnetic resonance imaging of the prostate after focal therapy with high-intensity focused ultrasound. Abdom Radiol. 2020;45:3882–95. https://doi.org/10.1007/s00261-020-02577-5.

    Article  Google Scholar 

  33. Kulik M, Nedelcu C, Martin F, Lebdai S, Rousselet MC, Azzouzi AR, et al. Post-treatment MRI aspects of photodynamic therapy for prostate cancer. Insights Imaging. 2014;5:697–713. https://doi.org/10.1007/s13244-014-0359-8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. van den Bos W, Scheltema MJ, Siriwardana AR, Kalsbeek AMF, Thompson JE, Ting F, et al. Focal irreversible electroporation as primary treatment for localized prostate cancer. BJU Int. 2018;121:716–24. https://doi.org/10.1111/bju.13983.

    Article  PubMed  CAS  Google Scholar 

  35. Kirkham AP, Emberton M, Hoh IM, Illing RO, Freeman AA, Allen C. MR imaging of prostate after treatment with high-intensity focused ultrasound. Radiology. 2008;246:833–44. https://doi.org/10.1148/radiol.2463062080.

    Article  PubMed  Google Scholar 

  36. Koopman AGMM, Jenniskens SFM, Fütterer JJ. Magnetic resonance imaging assessment after therapy in prostate cancer. Top Magn Reson Imaging. 2020;29:47–58. https://doi.org/10.1097/RMR.0000000000000231.

    Article  PubMed  Google Scholar 

  37. Muller BG, Fütterer JJ, Gupta RT, Katz A, Kirkham A, Kurhanewicz J, et al. The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: recommendations from a consensus panel. BJU Int. 2014;113:218–27. https://doi.org/10.1111/bju.12243.

    Article  PubMed  Google Scholar 

  38. Light A, Mayor N, Cullen E, Kirkham A, Padhani AR, Arya M, et al. The Transatlantic Recommendations for Prostate Gland Evaluation with Magnetic Resonance Imaging After Focal Therapy (TARGET): A systematic review and international consensus recommendations. Eur Urol. 2024;S0302-2838:00067–8. https://doi.org/10.1016/j.eururo.2024.02.001.

    Article  Google Scholar 

  39. Guillaumier S, Peters M, Arya M, Afzal N, Charman S, Dudderidge T, et al. A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer. Eur Urol. 2018;74:422–9. https://doi.org/10.1016/j.eururo.2018.06.006.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Stabile A, Orczyk C, Hosking-Jervis F, Giganti F, Arya M, Hindley RG, et al. Medium-term oncological outcomes in a large cohort of men treated with either focal or hemi-ablation using high-intensity focused ultrasonography for primary localized prostate cancer. BJU Int. 2019;124:431–40. https://doi.org/10.1111/bju.14710.

    Article  PubMed  Google Scholar 

  41. Marra G, Soeterik T, Oreggia D, Tourinho-Barbosa R, Moschini M, Stabile A, et al. Focal high-intensity focused ultrasound vs. active surveillance for ISUP Grade 1 prostate cancer: medium-term results of a matched-pair comparison. Clin Genitourin Cancer. 2022;20:592–604. https://doi.org/10.1016/j.clgc.2022.06.009.

    Article  PubMed  Google Scholar 

  42. O’Connor LP, Lebastchi AH, Horuz R, Rastinehad AR, Siddiqui MM, Grummet J, et al. Role of multiparametric prostate MRI in the management of prostate cancer. World J Urol. 2021;39:651–9. https://doi.org/10.1007/s00345-020-03310-z.

    Article  PubMed  Google Scholar 

  43. Schaudinn A, Michaelis J, Franz T, Ho-Thi P, Horn LC, Blana A, et al. High-intensity focused ultrasound (HIFU) hemiablation of the prostate: Late follow-up MRI findings in non-recurrent patients. Eur J Radio. 2021;144:109957 https://doi.org/10.1016/j.ejrad.2021.109957.

    Article  Google Scholar 

  44. van den Bos W, de Bruin DM, van Randen A, Engelbrecht MR, Postema AW, Muller BG, et al. MRI and contrast-enhanced ultrasound imaging for evaluation of focal irreversible electroporation treatment: results from a Phase I–II study in patients undergoing IRE followed by radical prostatectomy. Eur Radio. 2016;26:2252–60.

    Article  Google Scholar 

  45. Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, et al. Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system Version 2. Eur Urol. 2019;76:340–51. https://doi.org/10.1016/j.eururo.2019.02.033.

    Article  PubMed  Google Scholar 

  46. Giganti F, Dickinson L, Orczyk C, Haider A, Freeman A, Emberton M, et al. Prostate Imaging after Focal Ablation (PI-FAB): A proposal for a scoring system for multiparametric MRI of the prostate after focal therapy. Eur Urol Oncol. 2023;6:629–34. https://doi.org/10.1016/j.euo.2023.04.007.

    Article  PubMed  Google Scholar 

  47. Wysock JS, Becher E, Gogaj R, Velazquez N, Lepor H. Early oncological control following partial gland cryo-ablation: a prospective experience specifying reflex MRI guided biopsy of the ablation zone. Prostate Cancer Prostat Dis. 2021;24:114–9. https://doi.org/10.1038/s41391-020-0244-0.

    Article  Google Scholar 

  48. Geboers B, Gondoputro W, Thompson JE, Reesink DJ, van Riel LAMJG, Zhang D, et al. Diagnostic accuracy of multiparametric magnetic resonance imaging to detect residual prostate cancer following irreversible electroporation-a multicenter validation study. Eur Urol Focus. 2022;8:1591–8. https://doi.org/10.1016/j.euf.2022.04.010.

    Article  PubMed  Google Scholar 

  49. Kaufmann B, Raess E, Schmid FA, Bieri U, Scherer TP, Elleisy M, et al. Focal therapy with high-intensity focused ultrasound for prostate cancer: 3-year outcomes from a prospective trial. BJU Int. 2024;133:413–24. https://doi.org/10.1111/bju.16213.

    Article  PubMed  Google Scholar 

  50. Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389:815–22. https://doi.org/10.1016/S0140-6736(16)32401-1.

    Article  PubMed  Google Scholar 

  51. Light A, Kanthabalan A, Otieno M, Pavlou M, Omar R, Adeleke S, et al. The role of multiparametric MRI and MRI-targeted biopsy in the diagnosis of radiorecurrent prostate cancer: an analysis from the FORECAST trial. Eur Urol. 2024;85:35–46. https://doi.org/10.1016/j.eururo.2023.09.001.

    Article  PubMed  Google Scholar 

  52. Felker ER, Raman SS, Lu DSK, Tuttle M, Margolis DJ, ElKhoury FF, et al. Utility of multiparametric MRI for predicting residual clinically significant prostate cancer after focal laser ablation. Am J Roentgenol. 2019;213:1253–8. https://doi.org/10.2214/AJR.19.21637.

    Article  Google Scholar 

  53. Scheltema MJ, Chang JI, van den Bos W, Böhm M, Delprado W, Gielchinsky I, et al. Preliminary diagnostic accuracy of multiparametric magnetic resonance imaging to detect residual prostate cancer following focal therapy with irreversible electroporation. Eur Urol Focus. 2019;5:585–91. https://doi.org/10.1016/j.euf.2017.10.007.

    Article  PubMed  Google Scholar 

  54. Thompson JE, Sridhar AN, Tan WS, Freeman A, Haider A, Allen C, et al. Pathological findings and magnetic resonance imaging concordance at salvage radical prostatectomy for local recurrence following partial ablation using high intensity focused ultrasound. J Urol. 2019;201:1134–43. https://doi.org/10.1097/JU.0000000000000135.

    Article  PubMed  Google Scholar 

  55. Donato P, Morton A, Yaxley J, Ranasinghe S, Teloken PE, Kyle S, et al. 68Ga-PSMA PET/CT better characterises localised prostate cancer after MRI and transperineal prostate biopsy: Is 68Ga-PSMA PET/CT guided biopsy the future? Eur J Nucl Med Mol Imaging. 2020;47:1843–51. https://doi.org/10.1007/s00259-019-04620-0.

    Article  PubMed  Google Scholar 

  56. Spohn S, Jaegle C, Fassbender TF, Sprave T, Gkika E, Nicolay NH, et al. Intraindividual comparison between 68Ga-PSMA-PET/CT and mpMRI for intraprostatic tumor delineation in patients with primary prostate cancer: a retrospective analysis in 101 patients. Eur J Nucl Med Mol Imaging. 2020;47:2796–803. https://doi.org/10.1007/s00259-020-04827-6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  57. Roberts MJ, Morton A, Donato P, Kyle S, Pattison DA, Thomas P, et al. 68Ga-PSMA PET/CT tumour intensity pre-operatively predicts adverse pathological outcomes and progression-free survival in localised prostate cancer. Eur J Nucl Med Mol Imaging. 2021;48:477–82. https://doi.org/10.1007/s00259-020-04944-2.

    Article  PubMed  CAS  Google Scholar 

  58. Raveenthiran S, Yaxley WJ, Franklin T, Coughlin G, Roberts M, Gianduzzo T, et al. Findings in 1,123 men with preoperative 68Ga-prostate-specific membrane antigen positron emission tomography/computerized tomography and multiparametric magnetic resonance imaging compared to totally embedded radical prostatectomy histopathology: implications for the diagnosis and management of prostate cancer. J Urol. 2022;207:573–80. https://doi.org/10.1097/JU.0000000000002293.

    Article  PubMed  CAS  Google Scholar 

  59. Pfister D, Haidl F, Nestler T, Verburg F, Schmidt M, Wittersheim M, et al. 68 Ga-PSMA-PET/CT helps to select patients for salvage radical prostatectomy with local recurrence after primary radiotherapy for prostate cancer. BJU Int. 2020;126:679–83. https://doi.org/10.1111/bju.15135.

    Article  PubMed  Google Scholar 

  60. Alvim R, Nagar K, Das S, Lebdai S, Wong N, Somma A, et al. Positron Emission Tomography/Computed Tomography with Gallium-68-labeled prostate-specific membrane antigen detects relapse after vascular-targeted photodynamic therapy in a prostate cancer model. Eur Urol Focus. 2021;7:472–8. https://doi.org/10.1016/j.euf.2019.06.008.

    Article  PubMed  Google Scholar 

  61. Blazevski A, Geboers B, Scheltema MJ, Gondoputro W, Doan P, Katelaris A, et al. Salvage irreversible electroporation for radio-recurrent prostate cancer - the prospective FIRE trial. BJU Int. 2023;131:23–31. https://doi.org/10.1111/bju.15947.

    Article  PubMed  CAS  Google Scholar 

  62. Rasing M, van Son M, Moerland M, de Keizer B, Wessels F, Jonges T, et al. Value of targeted biopsies and combined PSMA PET/CT and mp-MRI imaging in locally recurrent prostate cancer after primary radiotherapy. Cancers. 2022;14:781 https://doi.org/10.3390/cancers14030781.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  63. Manfredi C, Fernández-Pascual E, Linares-Espinós E, Couñago F, Martínez-Salamanca JI. New frontiers in focal therapy for prostate cancer: Prostate-specific membrane antigen positron emission tomography/magnetic resonance imaging. World J Clin Oncol. 2021;12:61–68. https://doi.org/10.5306/wjco.v12.i2.61.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Burger IA, Müller J, Donati OF, Ferraro DA, Messerli M, Kranzbühler B, et al. 68Ga-PSMA-11 PET/MR detects local recurrence occult on mpmri in prostate cancer patients after HIFU. J Nucl Med. 2019;60:1118–23. https://doi.org/10.2967/jnumed.118.221564.

    Article  PubMed  CAS  Google Scholar 

  65. Duan H, Ghanouni P, Daniel B, Rosenberg J, Davidzon GA, Aparici CM, et al. A pilot study of 68Ga-PSMA11 and 68Ga-RM2 PET/MRI for evaluation of prostate cancer response to high-intensity focused ultrasound therapy. J Nucl Med. 2023;64:592–7. https://doi.org/10.2967/jnumed.122.264783.

    Article  PubMed  CAS  Google Scholar 

  66. Bacchetta F, Martins M, Regusci S, Jichlinski P, Meuwly JY, Lucca I, et al. The utility of intraoperative contrast-enhanced ultrasound in detecting residual disease after focal HIFU for localized prostate cancer. Urol Oncol. 2020;38:846.e1–846.e7. https://doi.org/10.1016/j.urolonc.2020.05.010.

    Article  PubMed  Google Scholar 

  67. van den Bos W, de Bruin DM, van Randen A, Engelbrecht MR, Postema AW, Muller BG, et al. MRI and contrast-enhanced ultrasound imaging for evaluation of focal irreversible electroporation treatment: results from a phase I-II study in patients undergoing IRE followed by radical prostatectomy. Eur Radiol. 2016;26:2252–60. https://doi.org/10.1007/s00330-015-4042-3.

    Article  PubMed  Google Scholar 

  68. van Riel LAMJG, van Kollenburg RAA, Freund JE, Almasian M, Jager A, Engelbrecht MRW, et al. Reliable visualization of the treatment effect of transperineal focal laser ablation in prostate cancer patients by magnetic resonance imaging and contrast-enhanced ultrasound imaging. Eur Urol Open Sci. 2023;54:72–79. https://doi.org/10.1016/j.euros.2023.06.002.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Muller BG, van den Bos W, Brausi M, Fütterer JJ, Ghai S, Pinto PA, et al. Follow-up modalities in focal therapy for prostate cancer: results from a Delphi consensus project. World J Urol. 2015;33:1503–9. https://doi.org/10.1007/s00345-014-1475-2.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  70. Siddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA. 2015;313:390–7. https://doi.org/10.1001/jama.2014.17942.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  71. Tan YG, Law YM, Ngo NT, Khor LY, Tan PH, Ong EHW, et al. Patient-reported functional outcomes and oncological control after primary focal cryotherapy for clinically significant prostate cancer: A Phase II mandatory biopsy-monitored study. Prostate. 2023;83:781–91. https://doi.org/10.1002/pros.24517.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  72. Blazevski A, Scheltema MJ, Yuen B, Masand N, Nguyen TV, Delprado W, et al. Oncological and quality-of-life outcomes following focal irreversible electroporation as primary treatment for localised prostate cancer: a biopsy-monitored prospective cohort. Eur Urol Oncol. 2020;3:283–90. https://doi.org/10.1016/j.euo.2019.04.008.

    Article  PubMed  Google Scholar 

  73. Ryan P, Finelli A, Lawrentschuk N, Fleshner N, Sweet J, Cheung C, et al. Prostatic needle biopsies following primary high intensity focused ultrasound (HIFU) therapy for prostatic adenocarcinoma: histopathological features in tumour and non-tumour tissue. J Clin Pathol. 2012;65:729–34. https://doi.org/10.1136/jclinpath-2011-200460.

    Article  PubMed  Google Scholar 

  74. Adams ES, Deivasigamani S, Mottaghi M, Huang J, Gupta RT, Polascik TJ. Evaluation of recurrent disease after radiation therapy for patients considering local salvage therapy: past vs. contemporary management. Cancers. 2023;15:5883 https://doi.org/10.3390/cancers15245883.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  75. Clements MB. How to present quality of life outcomes after focal therapy: using validated instruments and novel statistical methods. Curr Opin Urol. 2022;32:254–9. https://doi.org/10.1097/MOU.0000000000000974.

    Article  PubMed  Google Scholar 

  76. Shah TT, Peters M, Miah S, Eldred-Evans D, Yap T, Hosking-Jervis F, et al. Assessment of return to baseline urinary and sexual function following primary focal cryotherapy for nonmetastatic prostate cancer. Eur Urol Focus. 2021;7:301–8. https://doi.org/10.1016/j.euf.2019.09.004.

    Article  PubMed  Google Scholar 

  77. Fallara G, Capogrosso P, Maggio P, Taborelli A, Montorsi F, Dehò F, et al. Erectile function after focal therapy for localized prostate cancer: a systematic review. Int J Impot Res. 2021;33:418–27.

    Article  PubMed  Google Scholar 

  78. Bakavicius A, Marra G, Macek P, Robertson C, Abreu AL, George AK, et al. Available evidence on HIFU for focal treatment of prostate cancer: a systematic review. Int Braz J Urol. 2022;48:263–74. https://doi.org/10.1590/S1677-5538.IBJU.2021.0091.

    Article  PubMed  Google Scholar 

  79. Azzouzi AR, Vincendeau S, Barret E, Cicco A, Kleinclauss F, van der Poel HG, et al. Padeliporfin vascular-targeted photodynamic therapy versus active surveillance in men with low-risk prostate cancer (CLIN1001 PCM301): an open-label, phase 3, randomised controlled trial. Lancet Oncol. 2017;18:181–91. https://doi.org/10.1016/S1470-2045(16)30661-1.

    Article  PubMed  CAS  Google Scholar 

  80. Bakavicius A, Sanchez-Salas R, Muttin F, Sivaraman A, Dell’Oglio P, Barret E, et al. Comprehensive evaluation of focal therapy complications in prostate cancer: a standardized methodology. J Endourol. 2019;33:509–15. https://doi.org/10.1089/end.2018.0809.

    Article  PubMed  Google Scholar 

  81. Schmid FA, Schindele D, Mortezavi A, Spitznagel T, Sulser T, Schostak M, et al. Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer: Safety outcomes and complications. Urol Oncol. 2020;38:225–30. https://doi.org/10.1016/j.urolonc.2019.09.001.

    Article  PubMed  CAS  Google Scholar 

  82. Rakauskas A, Marra G, Heidegger I, Kasivisvanathan V, Kretschmer A, Zattoni F, et al. Focal therapy for prostate cancer: complications and their treatment. Front Surg. 2021;8:696242 https://doi.org/10.3389/fsurg.2021.696242.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Fiorella D, Marenco JL, Mascarós JM, Borque-Fernando Á, Esteban LM, Calatrava A, et al. Role of PCA3 and SelectMDx in the optimization of active surveillance in prostate cancer. Actas Urol Esp (Engl Ed) 2021;45:439–46.

    Article  PubMed  CAS  Google Scholar 

  84. Herlemann A, Huang HC, Alam R, Tosoian JJ, Kim HL, Klein EA, et al. Decipher identifies men with otherwise clinically favorable-intermediate risk disease who may not be good candidates for active surveillance. Prostate Cancer Prostat Dis. 2020;23:136–43. https://doi.org/10.1038/s41391-019-0167-9.

    Article  Google Scholar 

  85. Meeks JJ, Kern SQ, Dalbagni G, Eastham JA, Sandhu JS. The prevalence of persistent prostate cancer after radiotherapy detected at radical cystoprostatectomy for bladder cancer. J Urol. 2014;191:1760–3. https://doi.org/10.1016/j.juro.2013.12.037.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. These authors contributed equally: Giancarlo Marra, Alessandro Marquis.

Authors and Affiliations

  1. Division of Urology, Department of Surgical Sciences, City of Health and Science, Molinette Hospital and University of Turin, Turin, Italy

    Giancarlo Marra & Alessandro Marquis

  2. Smith Institute for Urology, Zucker School of Medicine at Hofstra/Northwell University, New York, NY, USA

    Alessandro Marquis

  3. Department of Urology, Pôle Saint Germain Centre Hospitalier de Brive, Brive la Gaillarde, France

    Michel Suberville

  4. Department of Urology, Blacktown Mount Druitt Hospitals, Blacktown, NSW, Australia

    Henry Woo

  5. Department of Uro-Oncology, Chris O’Brien Lifehouse, Camperdown, NSW, Australia

    Henry Woo

  6. Department of Urology of ROSUNIMED, Botkin Hospital, Moscow, Russia

    Alexander Govorov

  7. HoPe Robotic Urology, Hospital Angeles, Tijuana, Mexico

    Andres Hernandez-Porras

  8. Urology Department, Hamad Medical Corporation, Alkhor, Qatar

    Kamran Bhatti

  9. Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA

    Baris Turkbey

  10. Department of Urology, NYU Winthrop Hospital, Garden City, NY, USA

    Aaron E. Katz

  11. Department of Urology and Duke Cancer Institute, Duke Medical Center, Durham, NC, USA

    Thomas J. Polascik

Authors
  1. Giancarlo Marra
    View author publications

    Search author on:PubMed Google Scholar

  2. Alessandro Marquis
    View author publications

    Search author on:PubMed Google Scholar

  3. Michel Suberville
    View author publications

    Search author on:PubMed Google Scholar

  4. Henry Woo
    View author publications

    Search author on:PubMed Google Scholar

  5. Alexander Govorov
    View author publications

    Search author on:PubMed Google Scholar

  6. Andres Hernandez-Porras
    View author publications

    Search author on:PubMed Google Scholar

  7. Kamran Bhatti
    View author publications

    Search author on:PubMed Google Scholar

  8. Baris Turkbey
    View author publications

    Search author on:PubMed Google Scholar

  9. Aaron E. Katz
    View author publications

    Search author on:PubMed Google Scholar

  10. Thomas J. Polascik
    View author publications

    Search author on:PubMed Google Scholar

Contributions

Study concept and design: Marra, Marquis, Polascik. Acquisition of data and reviewing journal articles: Marra, Marquis. Analysis and interpretation of data: All authors. Manuscript Draft: Marra, Marquis. Creating tables and images: All authors. Critical revision/editing of the manuscript: All authors. Supervision: Polascik.

Corresponding author

Correspondence to Alessandro Marquis.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marra, G., Marquis, A., Suberville, M. et al. Surveillance after Focal Therapy – a Comprehensive Review. Prostate Cancer Prostatic Dis 28, 662–671 (2025). https://doi.org/10.1038/s41391-024-00905-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41391-024-00905-0

Search

Advanced search

Quick links