Management of localised prostate cancer ranges from active surveillance, which carries risks of disease progression, to whole-gland treatment, which is associated with significant functional morbidity. Focal laser ablation (FLA) offers a targeted approach to tumour destruction while preserving surrounding tissue. This review aimed to evaluate the oncological control and functional outcomes of FLA in prostate cancer.

This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. An electronic literature search was conducted to identify all relevant studies evaluating FLA for localised prostate cancer. The primary outcome was oncological control, assessed through recurrence at follow-up biopsy and reduction in PSA. Secondary outcomes included functional outcomes, specifically sexual function and urinary symptoms, which were assessed by the Sexual Health Inventory For Men (SHIM) score and International Prostate Symptom Score (IPSS).

The search identified 12 studies for inclusion. A total of 421 patients underwent FLA for localised prostate cancer. The rate of recurrence of clinically significant cancer (ISUP ≥2) on initial biopsy following FLA (range 3-12 months) was 15% (95% CI 11% to 21%). The mean reduction in PSA at 12-months post-FLA was 2.3 ng/ml (95% CI 1.5 to 3.2). There was a change in SHIM scores post-operatively of -1.9 (95% CI -2.9 to -0.88), which was statistically significant (p <0.001), but not clinically significant (Cohens d = 0.29). There was no statistically significant change in urinary function following FLA.

The present systematic review and meta-analysis found that FLA provides oncological control comparable to other focal therapies while preserving functional outcomes. However, the limited availability of high-quality comparative studies highlights the need for further robust studies to validate these findings.