Guidelines of guidelines: Focal therapy for prostate cancer, is it time for consensus?

INTRODUCTION: Focal therapy (FT) for prostate cancer (PCa) encompasses a group of minimally invasive techniques used to focally ablate an area of PCa whilst preserving the surrounding benign tissue. The evidence for FT is currently limited and as such, Urological guidelines do not offer much guidance for clinicians. However, multiple consensus statements have been published on several aspects of FT. This article contains a summary and discussion of international guidelines, position statements and consensus statements in relation to FT. METHODS: EAU-EANM-ESTRO-ESUR-ISUP-SIOG and AUA/ASTRO/SUO guidelines were interrogated for recommendations for FT. PubMed and Ovid Medline were searched for consensus statements. Only studies in English since 2015 were included. Reference lists of the included articles were also interrogated and a manual search for studies was also performed. RESULTS: Our results showed a lack of long-term randomised data for FT. International Urological guidelines emphasised the need for more high-quality clinical trials with robust oncological and toxicity outcomes. Consensus and positions statements were heterogenous. CONCLUSION: A globally accepted guideline for FT planning, technique and follow up are still yet to be determined. Well-designed studies with long term follow up and robust clinical and toxicity endpoints are needed to improve our understanding of FT and create uniform guidelines to streamline management and follow up.