Focal therapy (FT) for localised prostate cancer has been increasingly utilised in recent years and it is a promising alternative to radical treatments in well selected patients. To date, outcomes of focal therapy in Asian populations have not been comprehensively evaluated. We aimed to perform a review of the contemporary literature and meta-analysis of oncological and functional outcomes after primary focal therapy for prostate cancer in Asian populations.

A search was performed using PubMed, Embase and Scopus to include all Asian studies reporting outcomes of FT. We describe the selection criteria, diagnostic tools, treatment modalities, and surveillance protocols. Oncological outcomes were defined by presence of clinically significant prostate cancer and retreatment rates. Functional outcomes using composite questionnaires were evaluated.

The search protocol yielded 14 studies, of which 9 were prospective and 5 were retrospective studies. The total number of patients included was 899 (from inception to September 2024). For patient selection, thirteen studies mandated multiparametric MRI and 11 studies integrated both targeted and systematic biopsies, and an average of 2 positive cores (range: 1-4 cores). 12 studies reported on risk stratification of recruited patients. Overall, 22.8% had low risk, 71.7% had intermediate and 5.8% had high risk (ISUP 4) disease. For energy modality, 4 studies reported on brachytherapy, 1 on cryotherapy, 6 on high-intensity focused ultrasound (HIFU), 2 on irreversible electroporation (IRE) and 1 on microwave ablation (MWA). Seven studies reported minimal major complications (<2% Clavien-Dindo >2). Median follow-up ranged from 6 to 68 months. Post-FT biopsy was mandatory in 9/14 (64.2%) cohorts. The pooled post-treatment biopsy rate of these studies was 89%. All except 1 study reported on recurrence based on biopsy results post-treatment. The pooled clinically significant recurrence (ISUP grade group ≥2) rate was 9.9% (range=5.3-21.4%). 11 studies reported on infield recurrence (4.4%, range=0-14.3%) and outfield recurrence (7.8%, range=5.3%-21.6%). Ten studies reported retreatment strategy, with the pooled retreatment rate (10.5%, range=2.8-25.0%). 4.7% (range=0-16.7%) had repeat focal therapy, 4.5% (range=1.8-13.3%) had radical treatment 1.2% (range=2.9-5.3%) had hormonal treatment. Functional outcomes were assessed in 12 studies, with EPIC/IPSS/IIEF being the commonest used questionnaires. Urinary scores were similar to baseline with >90% complete continence. Three studies reported mild sexual deterioration at 12 months post-FT (-2.2 to -2.9 point reduction on IIEF). The overall risk of bias in the included literature was deemed to be moderate.

FT is an emerging treatment option for Asian patients with prostate cancer. Most published studies have standardized selection criteria which have led to considerably good cancer control and minimal morbidities.