Multimodality focal therapy for prostate cancer: outcome of the à la carte approach in clinical practice

Chi-Hang Yee; Peter K-F Chiu; Alex Q Liu; H F Wong; Wilson H C Chan; K L Lo; C K Chan; R Chan; Carmen Cm Cho; H Y Hung; Jeremy Y C Teoh; C F Ng

doi:10.1016/j.prnil.2025.03.006

Multimodality focal therapy for prostate cancer: outcome of the à la carte approach in clinical practice

Prostate Int. 2025 Dec;13(4):201-206. doi: 10.1016/j.prnil.2025.03.006. Epub 2025 Mar 24.

Authors

Chi-Hang Yee¹, Peter K-F Chiu¹, Alex Q Liu¹, H F Wong¹, Wilson H C Chan¹, K L Lo¹, C K Chan¹, R Chan², Carmen Cm Cho³, H Y Hung³, Jeremy Y C Teoh¹, C F Ng¹

Affiliations

¹ S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, China.
² Department of Anatomical and Cellular Pathology and State Key Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, China.
³ Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, China.

Abstract

Background: Our study reported the outcome of a multimodality focal therapy (FT) cohort for localized primary prostate cancer.

Methods: In a prospective registry all patients underwent magnetic resonance imaging and biopsy (fusion targeted or template biopsy) before FT. Modalities included focal high-intensity focused ultrasound (HIFU), focal cryotherapy, or targeted microwave ablation (TMA). Postoperatively, prostate-specific antigen and functional outcome assessment with validated questionnaires were checked 3 monthly. Magnetic resonance imaging was performed at 1 week, 6 months, and 12 months. Elective prostate biopsy was performed between 6 and 12 months.

Results: A total of 102 patients underwent FT between 2019 and 2024. The cohort consisted of 44 (43.1%) patients for focal HIFU, 18 (17.6%) patients for focal cryotherapy, and 40 (39.2%) patients for TMA. D'Amico low-, intermediate-, and high-risk patients accounted for 31 (30.4%), 66 (64.7%), and 5 (4.9%) patients, respectively. Referring to tumor location, focal HIFU had 38 (86.4%) posterior tumors, focal cryotherapy had 12 (72.2%) anterior tumors, and TMA had 31 (77.5%) anterior tumors. Biopsy data were available for 63 patients (61.8%). Clinically significant recurrence (International Society of Urological Pathology grade group: ≥2) were found in 7 patients (11.1%). Subsequent salvage treatment included the following cases: robotic radical prostatectomy: 2, radiotherapy: 4, and second focal cryotherapy: 1. No deterioration in Expanded Prostate Cancer Index Composite score was observed across all domains before and after the treatment. Improvement in the Urinary Irritative/Obstructive domain was observed in focal cryotherapy (78.3 vs. 91.5, P = 0.011) and TMA (75.7 vs. 84.9, P = 0.019) at 12 months.

Conclusions: Multimodality FT with à la carte approach provides versatility in ablative strategies and offers a reasonable functional and oncological outcome for low- to intermediate-risk prostate cancer.

Keywords: Focal therapy; Prostate cancer.