Evidence map›Paper›PMID 23769825›Full record

SynthesisEuropean urology2014

The role of focal therapy in the management of localised prostate cancer: a systematic review.

Massimo Valerio, Hashim U Ahmed, Mark Emberton, Nathan Lawrentschuk, Massimo Lazzeri, Rodolfo Montironi, Paul L Nguyen, John Trachtenberg, Thomas J Polascik

Open access · hybridAbstract readComparative StudySystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European urology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 150 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
150citing papers in PubMed, 7 pooled it
30.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

150 citing papers in PubMed, 7 syntheses or guidelines pooled it, 358 citations in OpenAlex.

  1. Pooled it
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  5. Primary cryotherapy for localised or locally advanced prostate cancer.The Cochrane database of systematic reviews · 2018
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  7. Available evidence on HIFU for focal treatment of prostate cancer: a systematic review.International braz j urol : official journal of the Brazilian Society of Urology
    Pooled it
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  20. Prostate Cancer: Etiology, Diagnosis, and Treatment.Serican journal of medicine · 2026
    Article

90 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 8 institutions in 6 countries.

Massimo ValerioDivision of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College Hospitals NHS Foundation Trust, London, UK; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Electronic address: massimo.valerio@chuv.ch.
Hashim U AhmedDivision of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College Hospitals NHS Foundation Trust, London, UK.
Mark EmbertonDivision of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College Hospitals NHS Foundation Trust, London, UK.
Nathan LawrentschukDepartment of Surgery, University of Melbourne; and Ludwig Institute for Cancer Research, Austin Hospital, Melbourne, Australia.
Massimo LazzeriDepartment of Urology, Ospedale San Raffaele Turro, San Raffaele Scientific Institute, Milan, Italy.
Rodolfo MontironiSection of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy.
Paul L NguyenDepartment of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Centre, Harvard Medical School, Boston, MA, USA.
John TrachtenbergDivision of Urology, Department of Surgical Oncology, University Health Network; and Department of Surgery, University of Toronto, Toronto, ON, Canada.
Thomas J PolascikDivision of Urology, Department of Surgery, and Duke Cancer Institute, Duke University Medical Centre, Durham, NC, USA.
University College London Hospitals NHS Foundation Trust · GBDana-Farber Brigham Cancer Center · USDuke Medical Center · USIRCCS Ospedale San Raffaele · ITMarche Polytechnic University · ITUniversity Hospital of Lausanne · CHUniversity of Melbourne · AUUniversity of Toronto · CA

Funding

Medical Research Council G0701302Medical Research Council G1002509Prostate Cancer UK G2011/53
6 · The paper itself

Abstract

contextThe incidence of localised prostate cancer is increasing worldwide. In light of recent evidence, current, radical, whole-gland treatments for organ-confined disease have being questioned with respect to their side effects, cancer control, and cost. Focal therapy may be an effective alternative strategy.

objectiveTo systematically review the existing literature on baseline characteristics of the target population; preoperative evaluation to localise disease; and perioperative, functional, and disease control outcomes following focal therapy. EVIDENCE ACQUISITION: Medline (through PubMed), Embase, Web of Science, and Cochrane Review databases were searched from inception to 31 October 2012. In addition, registered but not yet published trials were retrieved. Studies evaluating tissue-preserving therapies in men with biopsy-proven prostate cancer in the primary or salvage setting were included. EVIDENCE SYNTHESIS: A total of 2350 cases were treated to date across 30 studies. Most studies were retrospective with variable standards of reporting, although there was an increasing number of prospective registered trials. Focal therapy was mainly delivered to men with low and intermediate disease, although some high-risk cases were treated that had known, unilateral, significant cancer. In most of the cases, biopsy findings were correlated to specific preoperative imaging, such as multiparametric magnetic resonance imaging or Doppler ultrasound to determine eligibility. Follow-up varied between 0 and 11.1 yr. In treatment-naïve prostates, pad-free continence ranged from 95% to 100%, erectile function ranged from 54% to 100%, and absence of clinically significant cancer ranged from 83% to 100%. In focal salvage cases for radiotherapy failure, the same outcomes were achieved in 87.2-100%, 29-40%, and 92% of cases, respectively. Biochemical disease-free survival was reported using a number of definitions that were not validated in the focal-therapy setting.

conclusionsOur systematic review highlights that, when focal therapy is delivered with intention to treat, the perioperative, functional, and disease control outcomes are encouraging within a short- to medium-term follow-up. Focal therapy is a strategy by which the overtreatment burden of the current prostate cancer pathway could be reduced, but robust comparative effectiveness studies are now required.

Indexed as

AgedCryotherapyDisease-Free SurvivalEvidence-Based MedicineHumansLaser TherapyMaleMiddle AgedNeoplasm InvasivenessNeoplasm StagingPatient SelectionPhotochemotherapyPrognosisProstatic NeoplasmsRisk AssessmentRoleBrachytherapyCryotherapyHigh-intensity focused ultrasoundLaser therapyPhotodynamic therapyProstate cancer

Identifiers

PMID23769825
PMCPMC4179888
OpenAlexW1991359895

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.