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Focal Therapy for Prostate Cancer: Complications and Their Treatment

Focal therapy is a modern alternative to selectively treat a specific part of the prostate harboring clinically significant disease while preserving the rest of the gland. The aim of this therapeutic approach is to retain the oncological benefit of active treatment and to minimize the side-effects o...

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Autores principales: Rakauskas, Arnas, Marra, Giancarlo, Heidegger, Isabel, Kasivisvanathan, Veeru, Kretschmer, Alexander, Zattoni, Fabio, Preisser, Felix, Tilki, Derya, Tsaur, Igor, van den Bergh, Roderick, Kesch, Claudia, Ceci, Francesco, Fankhauser, Christian, Gandaglia, Giorgio, Valerio, Massimo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311122/
https://www.ncbi.nlm.nih.gov/pubmed/34322516
http://dx.doi.org/10.3389/fsurg.2021.696242
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author Rakauskas, Arnas
Marra, Giancarlo
Heidegger, Isabel
Kasivisvanathan, Veeru
Kretschmer, Alexander
Zattoni, Fabio
Preisser, Felix
Tilki, Derya
Tsaur, Igor
van den Bergh, Roderick
Kesch, Claudia
Ceci, Francesco
Fankhauser, Christian
Gandaglia, Giorgio
Valerio, Massimo
author_facet Rakauskas, Arnas
Marra, Giancarlo
Heidegger, Isabel
Kasivisvanathan, Veeru
Kretschmer, Alexander
Zattoni, Fabio
Preisser, Felix
Tilki, Derya
Tsaur, Igor
van den Bergh, Roderick
Kesch, Claudia
Ceci, Francesco
Fankhauser, Christian
Gandaglia, Giorgio
Valerio, Massimo
author_sort Rakauskas, Arnas
collection PubMed
description Focal therapy is a modern alternative to selectively treat a specific part of the prostate harboring clinically significant disease while preserving the rest of the gland. The aim of this therapeutic approach is to retain the oncological benefit of active treatment and to minimize the side-effects of common radical treatments. The oncological effectiveness of focal therapy is yet to be proven in long-term robust trials. In contrast, the toxicity profile is well-established in randomized controlled trials and multiple robust prospective cohort studies. This narrative review summarizes the relevant evidence on complications and their management after focal therapy. When compared to whole gland treatments, focal therapy provides a substantial benefit in terms of adverse events reduction and preservation of genito-urinary function. The most common complications occur in the peri-operative period. Urinary tract infection and acute urinary retention can occur in up to 17% of patients, while dysuria and haematuria are more common. Urinary incontinence following focal therapy is very rare (0–5%), and the vast majority of patients recover in few weeks. Erectile dysfunction can occur after focal therapy in 0–46%: the baseline function and the ablation template are the most important factors predicting post-operative erectile dysfunction. Focal therapy in the salvage setting after external beam radiotherapy has a significantly higher rate of complications. Up to one man in 10 will present a severe complication.
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spelling pubmed-83111222021-07-27 Focal Therapy for Prostate Cancer: Complications and Their Treatment Rakauskas, Arnas Marra, Giancarlo Heidegger, Isabel Kasivisvanathan, Veeru Kretschmer, Alexander Zattoni, Fabio Preisser, Felix Tilki, Derya Tsaur, Igor van den Bergh, Roderick Kesch, Claudia Ceci, Francesco Fankhauser, Christian Gandaglia, Giorgio Valerio, Massimo Front Surg Surgery Focal therapy is a modern alternative to selectively treat a specific part of the prostate harboring clinically significant disease while preserving the rest of the gland. The aim of this therapeutic approach is to retain the oncological benefit of active treatment and to minimize the side-effects of common radical treatments. The oncological effectiveness of focal therapy is yet to be proven in long-term robust trials. In contrast, the toxicity profile is well-established in randomized controlled trials and multiple robust prospective cohort studies. This narrative review summarizes the relevant evidence on complications and their management after focal therapy. When compared to whole gland treatments, focal therapy provides a substantial benefit in terms of adverse events reduction and preservation of genito-urinary function. The most common complications occur in the peri-operative period. Urinary tract infection and acute urinary retention can occur in up to 17% of patients, while dysuria and haematuria are more common. Urinary incontinence following focal therapy is very rare (0–5%), and the vast majority of patients recover in few weeks. Erectile dysfunction can occur after focal therapy in 0–46%: the baseline function and the ablation template are the most important factors predicting post-operative erectile dysfunction. Focal therapy in the salvage setting after external beam radiotherapy has a significantly higher rate of complications. Up to one man in 10 will present a severe complication. Frontiers Media S.A. 2021-07-12 /pmc/articles/PMC8311122/ /pubmed/34322516 http://dx.doi.org/10.3389/fsurg.2021.696242 Text en Copyright © 2021 Rakauskas, Marra, Heidegger, Kasivisvanathan, Kretschmer, Zattoni, Preisser, Tilki, Tsaur, van den Bergh, Kesch, Ceci, Fankhauser, Gandaglia and Valerio. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
Rakauskas, Arnas
Marra, Giancarlo
Heidegger, Isabel
Kasivisvanathan, Veeru
Kretschmer, Alexander
Zattoni, Fabio
Preisser, Felix
Tilki, Derya
Tsaur, Igor
van den Bergh, Roderick
Kesch, Claudia
Ceci, Francesco
Fankhauser, Christian
Gandaglia, Giorgio
Valerio, Massimo
Focal Therapy for Prostate Cancer: Complications and Their Treatment
title Focal Therapy for Prostate Cancer: Complications and Their Treatment
title_full Focal Therapy for Prostate Cancer: Complications and Their Treatment
title_fullStr Focal Therapy for Prostate Cancer: Complications and Their Treatment
title_full_unstemmed Focal Therapy for Prostate Cancer: Complications and Their Treatment
title_short Focal Therapy for Prostate Cancer: Complications and Their Treatment
title_sort focal therapy for prostate cancer: complications and their treatment
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311122/
https://www.ncbi.nlm.nih.gov/pubmed/34322516
http://dx.doi.org/10.3389/fsurg.2021.696242
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