A narrative clinical trials review in the realm of focal therapy for localized prostate cancer

Background and Objective: The role of focal therapy in the treatment of localized prostate cancer is evolving. However, despite accumulating evidence, current guidelines and regulatory bodies refrain from endorsing focal therapy outside of clinical trials. Our goal was the to review the focal therapy realm for ongoing clinical trials and high impact recently published trials. Methods: Our comprehensive investigation includes an exhaustive review of ClinicalTrials.gov and PubMed databases, identifying and analyzing clinical trials with diverse modalities of focal therapy. In this review, we focused on critical ongoing and recently concluded clinical trials (2-15-2023) in the focal therapy realm. Key Content and Findings: We identified several trials on focal therapy at various stages of progression and various trial design. The trials study all different modalities of focal therapy including high-intensity focused ultrasound (HIFU), cryoablation, irreversible electroporation (IRE), focal laser ablation (FLA), transurethral ultrasound ablation (TULSA)-PRO (R), and Water Vapor ablation. The trials focus both on oncological outcomes and quality of life outcomes. Novel clinical trials study the additive impact of androgen deprivation therapy (ADT) to different focal therapy modalities. Conclusions: The exploration of focal therapy in prostate cancer holds promise for achieving oncological control while minimizing the impact on patients' quality of life. Continued research and trial results will play a pivotal role in delineating focal therapy's optimal role in the broader prostate cancer treatment spectrum.