FOCAL THERAPY FOR PROSTATE CANCER: A NARRATIVE REVIEW OF ONCOLOGICAL EFFICACY AND FUNCTIONAL OUTCOMES OF HIFU, IRE, AND CRYOABLATION METHODS
Abstract
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.
References
Anceschi, U., Prata, F., Flammia, R. S., Iannuzzi, A., Bologna, E., Licari, L. C., Proietti, F., Bove, A. M., Misuraca, L., Ferriero, M., Mastroianni, R., Brassetti, A., Tuderti, G., Papalia, R., Di Blasi, A., Guaglianone, S., Lugnani, F., Leonardo, C., & Simone, G. (2025). Tailoring treatment in localized prostate cancer: Comparative effectiveness of HIFU, cryoablation, and robot-assisted radical prostatectomy at 2-year follow-up: Insights from prospective institutional cohort. Cancers, 17(3), 412. https://doi.org/10.3390/cancers17172762
Cribbs, K. A., Manning, E. F., Zhou, J., Lahue, B. J., & Polascik, T. J. (2023). Real-world comparative safety and effectiveness of irreversible electroporation and high-intensity focused ultrasound for prostate cancer ablation. Urology, 172, 156-163. https://doi.org/10.1016/j.urology.2023.01.024
Dias, N., Rodriguez-Sanchez, L., Colandrea, G., Macek, P., & Cathelineau, X. (2022). Medium-term oncological outcomes of intermediate-risk prostate cancer treated with HIFU or cryotherapy: A single center 10-year experience. Archivio Italiano di Urologia e Andrologia, 94(4), 413-418. https://doi.org/10.4081/aiua.2022.4.413
Duan, H., & Iagaru, A. (2022). The use of advanced imaging in guiding the further investigation and treatment of primary prostate cancer. Cancer Imaging, 22(1), 45. https://doi.org/10.1186/s40644-022-00481-3
Faiella, E., Santucci, D., D'Amone, G., Cirimele, V., Vertulli, D., Bruno, A., Zobel, B. B., & Grasso, R. F. (2024). Focal minimally invasive treatment in localized prostate cancer: Comprehensive review of different possible strategies. Cancers, 16(4), 728. https://doi.org/10.3390/cancers16040765
Fujihara, A., & Ukimura, O. (2022). Focal therapy of localized prostate cancer. International Journal of Urology, 29(11), 1254-1263. https://doi.org/10.1111/iju.14991
Fuller, R. E., Pio, F., Murdock, A., & Whalen, M. J. (2023). Role of image-guided focal cryoablation in localized prostate cancer. Medicine Research Archives, 11(12), Article 4880. https://doi.org/10.18103/mra.v11i12.4880
George, A. K., Miocinovic, R., Patel, A. R., Lomas, D. J., Correa, A. F., Chen, D. Y. T., Rastinehad, A. R., Schwartz, M. J., Uchio, E. M., Sidana, A., Helfand, B. T., Gahan, J. C., Yu, A., Vourganti, S., Barqawi, A. B., Brisbane, W. G., Wysock, J. S., Polascik, T. J., McClure, T. D., & Coleman, J. A. (2024). A description and safety overview of irreversible electroporation for prostate tissue ablation in intermediate-risk prostate cancer patients: Preliminary results from the PRESERVE trial. Cancers, 16(12), 2209. https://doi.org/10.3390/cancers16122178
Ghoreifi, A., Kaneko, M., Peretsman, S., Iwata, A., Brooks, J., Shakir, A., Sugano, D., Cai, J., Cacciamani, G., Park, D., Lebastchi, A. H., Ukimura, O., Bahn, D., Gill, I., & Abreu, A. L. (2023). Patient-reported satisfaction and regret following focal therapy for prostate cancer: A prospective multicenter evaluation. European Urology Open Science, 50, 10-16. https://doi.org/10.1016/j.euros.2023.01.003
Kumar, R., Ghai, S., Finelli, A., Klotz, L., Kinnaird, A., Mannas, M., Bhindi, B., Sanchez-Salas, R., Anidjar, M., Ahmad, A., Chin, J., Inman, B., & Perlis, N. (2024). The use of focal therapy for the treatment of prostate cancer in Canada: Where are we, how did we get here, and where are we going? Canadian Urological Association Journal, 18(10), 325-334. https://doi.org/10.5489/cuaj.8888
Lasorsa, F., Biasatti, A., Orsini, A., Farah, G. M., Bignante, G., Pandolfo, S. D., Lambertini, L., Reddy, D., Damiano, R., Ditonno, P., Lucarelli, G., Autorino, R., & Vourganti, S. (2024). Focal therapy for prostate cancer: Recent advances and insights. Cancers, 17(1), 89. https://doi.org/10.3390/curroncol32010015
Mala, K. S., Plage, H., Mödl, L., Hofbauer, S., Friedersdorff, F., Schostak, M., Miller, K., Schlomm, T., & Cash, H. (2023). Follow-up of men who have undergone focal therapy for prostate cancer with HIFU—A real-world experience. Journal of Clinical Medicine, 12(22), 7089. https://doi.org/10.3390/jcm12227089
Nyk, Ł., Michalak, W., Szempliński, S., Wózniak, R., Krajewski, W., Zagożdżon, B., Kryst, P., Kamecki, H., & Poletajew, S. (2022). High-intensity focused-ultrasound focal therapy versus laparoscopic radical prostatectomy: A comparison of oncological and functional outcomes in low- and intermediate-risk prostate cancer patients. Journal of Personalized Medicine, 12(2), 259. https://doi.org/10.3390/jpm12020251
Popeneciu, I. V., Mohr, M. N., Strauß, A., Reichert, M., Leitsmann, C., & Trojan, L. (2024). Personalized treatment strategy in "low-risk prostate cancer active surveillance candidates" using irreversible electroporation: Prospective evaluation of feasibility, morbidity, functional and oncological outcomes. The World Journal of Men's Health, 42(4), 821-829. https://doi.org/10.5534/wjmh.230097
Ramalingam, V., McCarthy, C. J., Degerstedt, S., & Ahmed, M. (2023). Image-guided prostate cryoablation: State-of-the-art. Medicina, 59(9), 1595. https://doi.org/10.3390/medicina59091589
Rokan, N., & Reddy, D. (2025). Focal therapy in prostate cancer: Development, application and outcomes in the United Kingdom. BJUI Compass, 6(3), 318-326. https://doi.org/10.1002/bco2.70000
Rosta, G., Turba, S., Mun, D. H., Shehab, A., Saciri, L., Engelhardt, P. F., Weisz, P., Riedl, C., Ameli, G., Doblhammer, S., & Fajkovic, H. (2025). Focal therapy using high-intensity focused ultrasound for low- and intermediate-risk prostate cancer: Results from a prospective, multicenter feasibility trial. Cancers, 17(20), 3468. https://doi.org/10.3390/cancers17213429
Sandberg, M., Thole, D., Nowatzke, J., Underwood, G., Ye, E., Rais-Bahrami, S., Davis, R., & Rodriguez, A. (2025). Focal therapy for localized prostate cancer: A case series with cost analysis. Cancers, 17(16), 2805. https://doi.org/10.3390/curroncol32090476
Shoji, S. (2023). Focal therapy with high-intensity focused ultrasound for localized prostate cancer: Approval as advanced medical care and future outlook. Journal of Medical Ultrasonics, 51(1), 1-3. https://doi.org/10.1007/s10396-023-01401-z
Skribek, B., Szabó, A., Ács, J., Cavalcante, B. G. N., Sipos, B. D., Hegyi, P., Mátrai, P., Nyirády, P., Ács, N., Majoros, A., & Deák, P. Á. (2025). Oncological efficacy and safety of minimally invasive focal and whole-gland interventions in the treatment of low- and intermediate-risk prostate cancer: A systematic review and meta-analysis. Cancers, 17(17), 3015. https://doi.org/10.3390/cancers17172863
Suberville, M., Zhang, K., Woillard, J. B., Herafa, I., Ducoux, D., Nachef, R., Zhu, G., Teoh, J., Ng, C. F., Laguna, P., & de la Rosette, J. (2025). Oncological and functional outcomes of hemi-ablation versus focal ablation for localized prostate cancer using irreversible electroporation. Cancers, 17(12), 2053. https://doi.org/10.3390/cancers17132084
Tan, Y. G., Law, Y. M., Ngo, N. T., Ong, E. H. W., Ho, H. S. S., Kanesvaran, R., Gupta, R. T., Chua, M. L. K., Khor, L. Y., Tan, P. H., Tuan, J. K. L., Rozen, S., Yuen, J. S. P., & Tay, K. J. (2023). Patient-reported functional outcomes and oncological control after primary focal cryotherapy for clinically significant prostate cancer: A Phase II mandatory biopsy-monitored study. The Prostate, 83(6), 541-551. https://doi.org/10.1002/pros.24517
Tay, K. J., Fong, K. Y., Stabile, A., Dominguez-Escrig, J. L., Ukimura, O., Rodriguez-Sanchez, L., Blana, A., Becher, E., & Laguna, M. P. (2024). Established focal therapy—HIFU, IRE, or cryotherapy—where are we now?—A systematic review and meta-analysis. Prostate Cancer and Prostatic Diseases, 27(4), 651-662. https://doi.org/10.1038/s41391-024-00911-2
Yang, C. H., Barbulescu, D. V., Marian, L., Tung, M. C., & Ou, Y. C. (2024). High-intensity focus ultrasound ablation in prostate cancer: A systematic review. International Journal of Molecular Sciences, 26(1), 218. https://doi.org/10.3390/ijms26010218
Yaxley, W. J., Gianduzzo, T., Kua, B., Oxford, R., & Yaxley, J. W. (2022). Focal therapy for prostate cancer with irreversible electroporation: Oncological and functional results of a single institution study. Investigative and Clinical Urology, 63(3), 285-293. https://doi.org/10.4111/icu.20210472
Yee, C. H., Chan, C. K., Chan, R., Cho, C. C. M., Hung, H. Y., Teoh, J. Y. C., & Ng, C. F. (2025). Multimodality focal therapy for prostate cancer: Outcome of the "à la carte" approach in clinical practice. Prostate International, 13(2), 94-99. https://doi.org/10.1016/j.prnil.2025.01.003
Yu, A., Dinckal, M., & Pow-Sang, J. (2024). Surgical ablative therapies in patients with radiorecurrent prostate cancer. Cancer Control, 31, 1-9. https://doi.org/10.1177/10732748241280444
Zhang, K., Stricker, P., Löhr, M., Stehling, M., Suberville, M., Cussenot, O., Lunelli, L., Teoh, J., Ng, C. F., Laguna, P., & de la Rosette, J. (2024). A multi-center international study to evaluate the safety, functional and oncological outcomes of irreversible electroporation for the ablation of prostate cancer. Prostate Cancer and Prostatic Diseases, 27(2), 298-305. https://doi.org/10.1038/s41391-023-00783-y
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