title: How to diagnose and treat focal therapy failure and recurrence?
abstract: OBJECTIVE
  Focal therapy presents an alternative option for disease-targeted therapy while preserving erectile and urinary function without compromising oncological outcome. Such treatment, which preserves normal prostate parenchyma, presents a clinical challenge to the urologist, as typical disease surveillance parameters are not as reliable in post-ablation follow-up. We propose an integrated approach to post-ablation surveillance to identify treatment failure as well as recurrence.
  
  
  RESULTS
  Post-ablation prostate-specific antigen kinetics, imaging based on multiparametric MRI and control biopsies are the tools currently used to follow patients after focal therapy. Good treatment response is indicated by a negative control biopsy, absence of persistent lesion on post-treatment imaging and a reduction in prostate-specific antigen of at least 50%.
  
  
  CONCLUSIONS
  When histological evidence of therapeutic failure or recurrence is present, different options of management may be proposed to the patient including active surveillance, focal salvage therapy or radical salvage treatment, depending on the characteristics of the lesion found. A recommended post-ablation surveillance protocol is presented as well as a discussion of management strategies based on the data currently available.
authors.affiliation: Institut Montsouris, Paris-Descartes University, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Barret
authors.forename: Kadi-Ann
authors.initials: KA
authors.lastname: Harvey-Bryan
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanchez-Salas
authors.forename: Francois
authors.initials: F
authors.lastname: Rozet
authors.forename: Marc
authors.initials: M
authors.lastname: Galiano
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects*; D006801:Humans; D007610:Kallikreins / Q000097:blood; D008297:Male; D009364:Neoplasm Recurrence, Local; D059351:Organ Sparing Treatments; D018579:Patient Selection; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D012086:Reoperation; D012307:Risk Factors; D016879:Salvage Therapy; D013997:Time Factors; D017211:Treatment Failure
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen