The Italian Society of Urology Statement on focal therapy for localized prostate cancer

Focal therapy (FT) represents a promising strategy for the management of localized prostate cancer (PCa). However, due to limited long-term evidence and the heterogeneity of prostate cancer, its use must be carefully considered, and patient selection must be stringent. A panel of urologists with expertise in PCa and FT was selected by the Italian Society of Urology (SIU - Società Italiana di Urologia) and proposed criteria to consider in FT for PCa, with the aim of supporting its use in clinical practice. The ideal candidate for FT is a patient with a unilateral, localized, multiparametric MRI-visible lesion, harboring intermediate-risk PCa (ISUP Grade Group 2) and a life expectancy greater than 10 years. The different energy sources used in FT (cryotherapy, high-intensity focused ultrasound, irreversible electroporation, and transperineal laser ablation) offer comparable oncological and functional outcomes. The choice of energy modality primarily depends on tumor location, physician expertise, and local availability of the technology. Different FT failure definitions exist. Standard follow-up should always include PSA monitoring and mpMRI. Follow-up biopsy should not be routinely performed in every patient except for centers starting a FT program. Per protocol biopsy should be considered depending on the risk of PCa treated with FT. The SIU position paper on FT aims to guide its use in clinical practice by providing recommendations to select, treat and follow-up patients.