title: Surveillance following Focal Therapy interventions.
abstract: OBJECTIVE
  Focal therapy (FT) is a tissuesparing treatment paradigm for localized prostate cancer (PCa) with the potential to improve functional outcomes while maintaining oncologic safety. This paper aims to provide an overview of important considerations and practical recommendations relating to the follow-up after FT.
  
  
  METHODS
  Literature review of papers related to FT in PCa derived from Medline/Pubmed database.
  
  
  RESULTS
  The recommended minimum follow-up period after FT is 5 years. Standard history taking should include: signs of disease progression, treatment-related complications and psychological aspects. Oncological outcome is based on serial prostate specific antigen monitoring, follow-up imaging (most commonly with multiparametric magnetic resonance imaging) and repeat biopsies (systematic from entire gland or targeted from treated zone). Significant PCa has been found at biopsy in up to 17% of patients after FT. Functional outcomes are evaluated using standardized questionnaires that relate to urinary function, erectile function and quality of life. A systematic review reports urinary continence in 83-100% of patients, erections sufficient for penetration in 54-100%. Outcomes differ between ablative energies and treatment templates. The most common side effects after FT are urinary retention (0-17%), urinary tract infection (UTI) (0-17%) and urinary stricture (0-5%). Rectal fistula is a rare complication occurring in up to 0.1-2% of patients. Clavien-Dindo Grade 3-4 complications are reported in 0-4% of patients. Type and rate vary with treatment modality. Complications should be reported using standardized reporting systems. Most data on FT outcomes come from small heterogeneous trials. Pooling of standardized data is necessary to advance the field of FT.
  
  
  CONCLUSIONS
  Stringent follow-up after FT is required to confirm oncologic safety of the individual patient. Standardized data gathering and data pooling is necessary to evaluate whether FT can live up to its promise of improving functional outcomes while maintaining oncological safety.
authors.affiliation: Department of Urology. AMC University Hospital. Amsterdam. The Netherlands.
authors.forename: A W
authors.initials: AW
authors.lastname: Postema
authors.affiliation: Department of Urology. AMC University Hospital. Amsterdam. The Netherlands. Department of Urology. San Paolo Teaching Hospital. Milan. Italy.
authors.forename: M
authors.initials: M
authors.lastname: Catellani
authors.affiliation: Department of Urology. AMC University Hospital. Amsterdam. The Netherlands.
authors.forename: M J V
authors.initials: MJ
authors.lastname: Scheltema
authors.affiliation: Department of Urology. AMC University Hospital. Amsterdam. The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: van den Bos
authors.affiliation: Department of Urology. AMC University Hospital. Amsterdam. The Netherlands.
authors.forename: J J M C H
authors.initials: JJ
authors.lastname: de la Rosette
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D059351:Organ Sparing Treatments; D011471:Prostatic Neoplasms / Q000628:therapy*; D011788:Quality of Life; D020127:Recovery of Function; D016896:Treatment Outcome