Simple Summary
The standard of care for clinically localized prostate cancer (PCa) includes several options such as watchful waiting, active surveillance (AS), and whole gland treatments, which might have a non-negligible impact in terms of morbidity and quality of life. As a result, several focal therapy options have been developed to reduce the rate of side effects while ensuring good oncological outcomes and cancer control. For this scenario, transperineal laser ablation is proposed as a focal therapy option. The aim of this systematic review was to evaluate the available evidence on transperineal focal laser ablation focusing on both functional and oncological outcomes.
Abstract
Objectives: The aim of this work was to review the available evidence on transperineal focal laser ablation (FLA) for patients with localized PCa, focusing on both functional and oncological outcomes. Methods: A comprehensive review of the English-language literature was performed using the MEDLINE (via PubMed) and Web of Science (WOS) databases until 30 December 2024, using a combination of free text and MeSH subject headings. The review process was carried out according to the PRISMA guidelines. Results: The literature search found 156 papers, and among these, 10 papers were finally accepted and included. A risk of bias assessment was conducted, revealing low-quality evidence and high heterogeneity among the available data. Low- to high-risk cancers were treated across the studies. A drop in PSA values was observed in all studies after FLA, but no definition of biochemical disease-free survival was established. The postfocal presence of cancer rate ranged from 4% to 57%, while clinically significant cancer was detected in 0 up to 31% of cases. Secondary treatments were necessary for 7 to 30%. The overall complication rate ranged from 0% to 66%, most being mild and transient. Functional outcomes appeared to be preserved both in the short- and long-term follow-ups. Quantitative analyses were not performed due to the low number and heterogeneity of the studies included. Conclusions: Transperineal FLA for the treatment of clinically localized prostate cancer appears to be a feasible, safe technique with an efficacy comparable to other focal therapy modalities. However, the low quality of the evidence available highlights the need for comparative, randomized long-term follow-up studies versus standard of care and other focal therapy options in order to standardize patient selection, treatment protocols, and follow-up strategies.