Pathologic Rationale for Focal Therapy of Prostate Cancer: Elucidating Tumor Characteristics and Biology

The treatment paradigm for early-stage prostate cancer with small-volume, low-intermediate grade, unifocal or unilateral prostate cancer is shifting from a radical, whole-gland approach toward organ-sparing, focal ablation. An image-guided approach to focal therapy has yet to be realized and is dependent on the development of an imaging modality that detects cancer with high sensitivity and specificity. The future success of focal therapy will depend on adequate prostate sampling at biopsy, along with accurate characterization of the spatial distribution of tumor within the prostate. The pathologic evaluation of radical prostatectomy specimens remains of paramount importance, as this reference standard can validate all preoperative clinical, demographic, laboratory, imaging, and prostate biopsy findings creating a solid background for targeted focal ablation.