Focal Minimally Invasive Treatment in Localized Prostate Cancer: Comprehensive Review of Different Possible Strategies

Simple Summary This systematic review includes 23 studies about minimally invasive methods for selective treatment of localized prostate cancer. At present, standard treatment options for localized prostate cancer are active surveillance and whole-gland treatment (radical prostatectomy and radiotherapy). Regrettably, morbidities are represented by urinary incontinence, erectile dysfunction, and bowel dysfunction, which can worsen the quality of life without necessarily improving the patient's oncological outcome. Minimally invasive methods have demonstrated encouraging results in terms of functional outcomes and low adverse events. The focus of this review is to update evidence about the oncological effectiveness of three minimally invasive techniques (cryoablation, irreversible electroporation, and microwave ablation).Abstract Background: Focal therapy is a promising, minimally invasive method for the treatment of patients with localized prostate cancer. According to the existing literature, there is growing evidence for positive functional outcomes and oncological effectiveness. The aim of this review is to evaluate the technical efficacy of three minimally invasive techniques (cryoablation, electroporation, and microwave ablation) and their impact on quality of life in patients with prostate cancer. Methods: Studies between January 2020 and July 2023 were selected using PubMed, Embase, and The Cochrane Library and analyzed following PRISMA guidelines; they have not been registered. Results: Twenty-three studies investigating three different sources of energy to deliver focal therapy were found. Thirteen studies evaluated the performance of the cryoablation therapy, seven studies of the irreversible electroporation, and three studies of microwave ablation option. The majority of studies were retrospective cohort studies. Cryoablation showed excellent oncological outcomes for low-grade prostate cancer, whether performed on the lesion, on the hemigland, or on the entire gland, with the best results obtained for patients with intermediate risk. Irreversible electroporation showed promising oncological outcomes with no significant changes in functional outcomes. Microwave ablation showed great early functional outcomes. Conclusions: The oncological effectiveness of minimally invasive treatment in comparison to standard of care is still under investigation, despite encouraging results in terms of functional outcomes improvement and adverse events reduction. More comprehensive research is needed to fully understand the function of minimally invasive treatment in patients with localized PCa.