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Focal radiation therapies for localized prostate cancer: a systematic review of clinical evidence and outcomes

Prostate Cancer and Prostatic Diseases (2025)Cite this article

Subjects

Abstract

Background

Advances in imaging modalities and radiotherapy (RT) technologies have enabled the development of focal RT approaches for localized prostate cancer (PCa). This systematic review aims to evaluate the oncological and toxicity outcomes of focal or partial-gland RT, while also discussing the optimal patient selection criteria and treatment planning strategies for this emerging approach.

Methods

This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was performed on February, 2025, on Pubmed, with the keywords “focal RT” and “definitive” and “prostate cancer”; and “focal brachytherapy (BT)” and “definitive” and “prostate cancer”.

Results

Both focal BT and partial-gland stereotactic body radiotherapy (SBRT) strategies demonstrated a minimal impact on toxicity and quality of life parameters. Only a transient increase in urinary frequency was suggested at 6–12 months following focal treatment, returning to baseline thereafter. In highly selected low-risk (LR) and intermediate-risk (IR) PCa patients with both excellent radiological-histological concordance and a limited number of positive cores, focal RT demonstrated excellent biochemical relapse-free survival and metastasis-free survival, reaching up to 97% and 100% at 5 years. Subsequent intraprostatic relapse mostly occurred out-of-field, and were salvaged with either focal treatment or radical prostatectomy, with no signal of increased risk of severe toxicity.

Conclusion

Focal RT is associated with low toxicity rates, and excellent oncological outcomes. However, most studies recruited LR or favorable IR PCa, including patients eligible for active surveillance. Results from ongoing and future studies evaluating focal RT in IR PCa patients not eligible for active surveillance, and incorporating advanced imaging for target volume definition are eagerly awaited.

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Fig. 1: PRISMA flow-chart.

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Author information

Authors and Affiliations

  1. Laboratoire du traitement du signal et de l’image, Université de Rennes, Rennes, France

    Jennifer Le Guévelou

  2. Department of radiation therapy, CHRU Tours, Tours, France

    Jennifer Le Guévelou

  3. Department of Urology, Saint-Louis Hospital, Paris-Cité University, Paris, France

    Arthur Peyrottes

  4. Department of Urology, Institut Mutualiste Montsouris, Paris, France

    Eric Barret

  5. Department of Urology, La Croix du Sud Hôpital, Quint-Fonsegrives, France

    Guillaume Ploussard

  6. Department of Urology, Hôpital européen Georges-Pompidou, AP-HP, Paris University, U1151 Inserm-INEM, Necker, Paris, France

    Charles Dariane

  7. Department of Urology, Hôpital Cochin, AP-HP, Université Paris Cité, Paris, France

    Julien Anract

  8. Department of Urology, Claude Huriez Hospital, CHU Lille, Lille, France

    Jonathan Olivier

  9. Department of Radiation Oncology, hôpital Pitié Salpêtrière, Assistance publique-hôpitaux de Paris, Sorbonne université, Paris, France

    Cyrus Chargari

  10. Department of Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland

    Thomas Zilli

  11. Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland

    Thomas Zilli

  12. Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Thomas Zilli

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  1. Jennifer Le Guévelou
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Contributions

JLG: conceptualization, methodology, data curation, writing-original draft, visualization, AP: writing: review and editing, EB: writing: review and editing, GP: writing: review and editing, CD: writing: review and editing, JA: writing: review and editing, JO: CC: writing: review and editing, TZ: writing: review and editing, supervision.

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Correspondence to Jennifer Le Guévelou.

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Le Guévelou, J., Peyrottes, A., Barret, E. et al. Focal radiation therapies for localized prostate cancer: a systematic review of clinical evidence and outcomes. Prostate Cancer Prostatic Dis (2025). https://doi.org/10.1038/s41391-025-01050-y

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