Focal Therapy (FT) is an emerging treatment modality for prostate cancer (PCa). Due to its novelty, the research exploring how patients should be followed-up after treatment is limited. There is currently no established role for non-prostate-specific-antigen (PSA) biomarkers and PSMA PET. However, a combination of PSA testing, multiparametric magnetic resonance imaging (mpMRI), and systematic and targeted biopsies should routinely be used for surveillance after FT. PSA values that rise 1.0 ng/mL over the nadir after twelve months or rise 1.5 ng/mL over nadir after twenty-four to thirty-six months should raise suspicion for recurrence. The standard imaging technique is mpMRI, but it can often be difficult to interpret after FT, so using a scoring system such as prostate imaging after focal ablation (PI-FAB) or the transatlantic recommendations for prostate gland evaluation with magnetic resonance imaging after focal therapy (TARGET) allows for greater consistency between readers. This review seeks to summarize the current literature regarding surveillance after FT as it relates to biomarkers, imaging, biopsies, and consensus statements.

Purpose:Measurement of testosterone levels during androgen deprivation therapy (ADT) is broadly recommended, but how therapy should be altered in response to testosterone values during ADT remains ...

As the adoption of focal therapy (FT) for prostate cancer (PCa) grows, the demand for accurate post-treatment imaging to monitor outcomes and detect residual or recurrent cancer increases. Traditional diagnostic systems like the Prostate Imaging Reporting and Data System (PI-RADS) are ill-suited for post-FT evaluations due to treatment-induced tissue changes. MRI-based scoring systems specific for evaluation after FT have been developed to address these challenges and improve post-FT imaging accuracy by distinguishing benign alterations from recurrence. The currently developed scoring systems are Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET) and Prostate Imaging after Focal Ablation (PI-FAB). In this review, we describe and compare these two systems. These scoring systems standardize imaging assessments, enhance follow-up care, and support clinical decision-making. While promising, TARGET and PI-FAB require further large-scale validation to confirm their utility. Nevertheless, they represent critical advances in optimizing PCa management, particularly for patients undergoing FT, by improving diagnostic accuracy and guiding treatment decisions.

Background: Prostate cancer (PCa) diagnosis remains a complex field of study. Multiparametric magnetic resonance imaging (mpMRI) technology presents opportunities to enhance diagnostic precision. While recent advances in imaging and biopsy techniques show promise, the oncological implications of prebiopsy magnetic resonance imaging (MRI) and combination biopsy (ComBx) are not fully understood. This retrospective study evaluates the potential clinical impact of prebiopsy MRI and ComBx on PCa treatment outcomes. Methods: We conducted a comprehensive review of treatment-naïve patients undergoing prostate biopsy and subsequent radiation therapy (RT) or radical prostatectomy at the University of Cincinnati Health Center (2014–2020). Patients were categorized into two cohorts: those with prebiopsy mpMRI and ComBx versus those with systematic biopsy (SBx) alone. Patients with prostate-specific antigen (PSA) > 20 ng/mL were excluded. Biochemical recurrence (BCR) was defined as PSA ≥ 0.2 ng/mL post-prostatectomy or ≥2 ng/mL above nadir post-RT. Results: This study included 518 patients (189 SBx, 329 ComBx) with a median follow-up of 19.1 months. Median patient ages were 65.9 years (SBx) and 64.6 years (ComBx). The overall BCR rate was 10% with significantly lower rates in the ComBx group compared to SBx (6.4% vs. 16.4%, p < 0.001). Multivariable Cox regression analysis showed patients undergoing prebiopsy mpMRI with ComBx were 63% less likely to experience BCR (HR: 0.37, 95%CI 0.20–0.70, p = 0.002). Conclusions: Prebiopsy MRI followed by ComBx demonstrated lower BCR rates, suggesting improved PCa diagnosis and risk stratification. These findings highlight the potential of advanced imaging and biopsy techniques to benefit the management of PCa. Further longitudinal studies are needed to confirm the long-term clinical benefits of this approach.