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Background <p>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.</p> Methods <p>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”.</p> Results <p>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.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 发表日期：

    2025年11月4日

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  • Jennifer Le Guévelou,
  • Arthur Peyrottes,
  • Eric Barret,
  • Guillaume Ploussard,
  • Charles Dariane,
  • Julien Anract,
  • Jonathan Olivier,
  • Cyrus Chargari,
  • Thomas Zilli

摘要

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.