FOCAL THERAPY FOR PROSTATE CANCER: A NARRATIVE REVIEW OF ONCOLOGICAL EFFICACY AND FUNCTIONAL OUTCOMES OF HIFU, IRE, AND CRYOABLATION METHODS

This narrative review synthesizes current scientific evidence regarding oncological efficacy, functional outcomes, and safety profile of three leading focal therapy (FT) methods in the treatment of localized prostate cancer: high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE), and cryoablation. The analysis is based on 28 clinical studies published between 2022–2025, including prospective cohort studies, multicenter international trials, and meta-analyses. The results indicate that all analyzed ablative techniques offer acceptable oncological control while maintaining high patient quality of life. HIFU therapy provides the most established evidence, with a median biochemical recurrence-free survival (BCR-free survival) of 63 months and a low rate of clinically significant prostate cancer (csPCa) detection in control biopsy (6.5%). Oncological outcomes for IRE are more varied, with a csPCa detection rate of 24.1% in a multicenter study, suggesting strong dependence of efficacy on the extent of ablation (hemi-ablation vs. focal ablation). Cryoablation presents promising early oncological data, with 78.6% of patients free from csPCa at 12 months, but is associated with higher risk of erectile function impairment. Functionally, FT demonstrates clear superiority over radical treatment, with urinary incontinence rates at ~2% and significantly better preservation of potency. Key success factors for focal therapy include rigorous patient qualification based on advanced imaging techniques and precise procedure planning. Focal therapy represents a real and valuable therapeutic option for carefully selected groups of men with prostate cancer, offering a compromise between oncological radicality and preservation of vital functions.