Transperineal Focal Laser Ablation of the Prostate for Prostate Cancer: A Systematic Review of the Literature

Objectives: The aim of this work was to review the available evidence on transperineal focal laser ablation (FLA) for patients with localized PCa, focusing on both functional and oncological outcomes. Methods: A comprehensive review of the English-language literature was performed using the MEDLINE (via PubMed) and Web of Science (WOS) databases until 30 December 2024, using a combination of free text and MeSH subject headings. The review process was carried out according to the PRISMA guidelines. Results: The literature search found 156 papers, and among these, 10 papers were finally accepted and included. A risk of bias assessment was conducted, revealing low-quality evidence and high heterogeneity among the available data. Low- to high-risk cancers were treated across the studies. A drop in PSA values was observed in all studies after FLA, but no definition of biochemical disease-free survival was established. The postfocal presence of cancer rate ranged from 4% to 57%, while clinically significant cancer was detected in 0 up to 31% of cases. Secondary treatments were necessary for 7 to 30%. The overall complication rate ranged from 0% to 66%, most being mild and transient. Functional outcomes appeared to be preserved both in the short- and long-term follow-ups. Quantitative analyses were not performed due to the low number and heterogeneity of the studies included. Conclusions: Transperineal FLA for the treatment of clinically localized prostate cancer appears to be a feasible, safe technique with an efficacy comparable to other focal therapy modalities. However, the low quality of the evidence available highlights the need for comparative, randomized long-term follow-up studies versus standard of care and other focal therapy options in order to standardize patient selection, treatment protocols, and follow-up strategies.