Marieke van Son

36 CHAPTER 2 ences were found in patient-reported quality of life, although the variation of reported symptoms differed 7,39 . With respect to FT, there is evidence from observational retro- spective and prospective studies on different sources of ablative energy, showing that it has a significantly lower impact on genitourinary function 11 . The effectiveness of FT is currently being investigated within randomized clinical trials (RCT). A first feasibility study in the UK (PART) has completed recruitment of 80 patients with either unilateral clinically significant (ISUP 2-3 or >4mm grade 1) inter- mediate-risk prostate cancer or dominant unilateral cancer with small contralateral low-risk disease (ISRCTN 99760303). They concluded that it is feasible to randomize patients between prostatectomy and focal HIFU, with an achieved randomization rate of 50%, although the recruitment period had to be extended and the target lowered from 100 to 80. Compliance in the radical prostatectomy arm was also just under 80% 18 . A follow-up RCT is expected, aiming to randomize 800 patients between radical treatment (prostatectomy, EBRT or LDR-brachytherapy) and focal VTP. Another UK-based RCT (CHRONOS) is currently testing feasibility of recruiting patients to either an RCT of focal (cryotherapy or HIFU) versus radical therapy (EBRT or low-dose-rate brachytherapy or prostatectomy) or a separate multi-arm multi-stage RCT comparing focal alone to focal with neoadjuvant finasteride or bicalutamide (ISRCTN 17796995). In conclusion, within the confines and limitations of residual confounding that might be present, we found no clinically relevant difference in 6-year treatment failure-free sur- vival between conventional radical treatments and FT. Awaiting longer follow-up data from cohorts and initial results from RCTs, this study offers an insight into the potential of FT, potentially supporting its use in select patients with localized prostate cancer.