Advanced Imaging and Possible Focal Therapy for Prostate Cancer

Prostate cancer is the most commonly diagnosed cancer among European men with a rising incidence especially of early stage, organ-confined malignant lesions. In these patients, the current diagnostic and therapeutic strategy is insufficient with high risk of misclassification followed by over/under-diagnosis and over/under-treatment. In this context, focal therapy is an emerging option between active surveillance and radical therapeutic concepts. Focal therapy aims to reduce damage to non-cancerous tissues with minimal morbidity, while maintaining oncologic safety. Nevertheless, the concept of focal therapy relies on reliable cancer imaging and biopsy techniques to enable correct localization and characterization. In the near future, advances in ultrasound and MRI will help to allow better identification of clinically significant lesion. Furthermore, image-guided targeted biopsy techniques can offer improved cancer detection with fewer cores compared with systematic prostate sampling. These technologies are the platforms for future focal therapy. This review highlights recent developments in biopsy and imaging strategies to determine which is the most useful in diagnosing prostate cancer suitable for treatment with focal therapy.