Within this doctoral thesis, I evaluate outcomes of focal therapy as treatment for patients with localised, clinically significant prostate cancer. Focal therapy is a management option entailing the deliberate localised destruction of areas of the prostate affected by cancer, leaving untargeted tissue unharmed. It is an alternative to commonplace whole gland options such as radical radiotherapy or prostatectomy. The benefit to focal therapy is that it is a day-case procedure, unlike radical prostatectomy often resulting at least one night hospital stay, and radical radiotherapy requiring at least 30 visits to the treating centre. Complication rates reported in observational studies evaluating focal therapy are low, with serious adverse events reported in <5% of cases. Finally, genito-urinary function is well preserved following focal therapy, where early erectile dysfunction is reported in 95% and 69% of men following radical prostatectomy and radical radiotherapy respectively- a high proportion of these persist at 6 months. Early observational studies report erectile dysfunction in only 23% of patients following focal therapy. Such treatment is available at specialist centres, under specific clinical circumstances within the National Health Service in the UK.
First, I reviewed the literature to outline the current treatments available according to previous practices, and where diagnosis has become more accurate, and deeper understanding of how prostate cancer progresses, allowing for a shift in the treatment modalities a patient that may be offered.
Second, I determined how many patients diagnosed with prostate cancer using various diagnostic strategies are suitable for focal therapy. This is the first analysis of multiple cohorts of patients diagnosed with localised prostate cancer using PSA, pre-biopsy prostate MRI and transperineal image-guided prostate biopsy. Such an analysis is much more reflective of the real-life diagnostic pathway within the UK...