title: What is still needed to make focal therapy an accepted segment of standard therapy?
abstract: OBJECTIVE
  Focal therapy is gaining interest and this organ-preserving treatment is heading towards becoming an alternative for the conventional surgery and radiation. The purpose of this review is to determine what evidence is required to make focal therapy a viable option for treatment of localized prostate cancer.
  
  
  RESULTS
  There is still a lack of high-level evidence for the different focal treatment modalities. The early-stage focal therapy trials are conducted including a various selection of patients and different pretreatment assessment and follow-up, resulting in incomparable data. Recent literature shows it is paramount to extend the amount of biopsies and to alter the way of taking the biopsies with the template-assisted or image-guided approach. To date, multiparametric MRI is the most effective imaging technique in selecting patients for focal therapy.
  
  
  CONCLUSIONS
  Focal therapy trials are at the early stage of clinical development, with the majority still being phase I studies. To make focal therapy an accepted segment of standard therapy, it needs to proceed toward phase II and III trials. These trials should be conducted with an effective trial design, which will lead to more comparable oncological, functional and quality of life outcomes. Furthermore, it is essential to improve the localization of tumor foci in order to increase the accuracy of spatial targeting of cancer.
authors.affiliation: aDepartment of Urology, AMC University Hospital, Amsterdam, The Netherlands bDepartment of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Willemien
authors.initials: W
authors.lastname: van den Bos
authors.forename: Berrend G
authors.initials: BG
authors.lastname: Muller
authors.forename: Behfar
authors.initials: B
authors.lastname: Ehdaie
authors.forename: Peter
authors.initials: P
authors.lastname: Scardino
authors.forename: Jean J M C H
authors.initials: JJ
authors.lastname: de la Rosette
mesh_terms: D006801:Humans; D061705:Image-Guided Biopsy; D053783:Magnetic Resonance Imaging, Interventional / Q000592:standards; D008297:Male; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000592:standards*; D018579:Patient Selection; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D011881:Radiotherapy, Computer-Assisted / Q000009:adverse effects / Q000592:standards*; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000592:standards*; D016896:Treatment Outcome; D014463:Ultrasonography