If I asked you to think of an ancient Greek philosopher, names like Socrates or Plato might come to mind. It’s unlikely that the name Diogenes would spring to many lips. However, Diogenes is one of the founders of Cynicism, and his quips are often quoted. At some point in your life you might have come across one the following quotes without ever knowing it was from Diogenes:

• We have two ears and one tongue so that we would listen more and talk less.
• Poverty is a virtue which one can teach oneself.
• I am not an Athenian or a Greek, but a citizen of the world.

Diogenes also said, “The foundation of every state is the education of its youth.” These words might well be applied to authors of a research review regarding focal therapy in today’s world. The research team includes members of two professional societies. The first is the European Society of Residents in Urology (ESRU), composed of urologic surgeons in training. The second is Young Academic Urologists (YAU), devoted to urologists under 40 who are involved in clinical, educational and investigational projects.

Members of these two associations literally hold the future of prostate cancer (PCa) treatment. Their members understand that there’s a serious imbalance in radical (whole gland) treatments. A patient’s choice may control his cancer but risk sacrificing his sex life. Our young doctors are invested in a better balance for PCa patients. If Diogenes were a living urologist, he might well say, “The foundation of every PCa development is the education of young urologists.”

The article in question is titled, “Sexual function outcomes in men undergoing minimal invasive ablative techniques for prostate cancer: a ESRU/YAU urotech systematic review and pooled analysis.” (June 2025)^[i] Its 19 authors represent institutions in Italy, Greece, Croatia, Spain, Belgium, and even one in the U.S. (UCLA). Since they are all male, I can’t help but wonder if their gender gives them special empathy for the countless patients who have had a radical treatment, only to end up with temporary or even permanent impotence. In gathering data for their paper, the authors aimed “to summarize, evaluate and compare the impact of these focal therapies on the sexual function (erectile and ejaculatory function) of men harboring low to intermediate risk PCa.”

Between Oct. 2022 and Aug. 2024, they conducted a search of all journal articles on subtotal therapy outcomes, of which they identified 4465 papers. Then, they narrowed the inclusion criteria, eventually bringing the number down to 96 papers (87 single arm studies, 8 comparison studies, and 1 randomized prospective study) comprising 6244 patients/6469 procedures (focal, zonal or hemigland strategies).

Here are the treatment methods reported in the papers:

• HIFU – 2318 patients
• Cryo – 2034 patients
• Irreversible electroporation (IRE/NanoKnife) – 1194 patients
• Focal Laser Ablation (FLA) – 346 patients
• High-dose brachytherapy (HDB) – 147 patients
• Vascular photodynamic therapy (VPT/TOOKAD) – 247 patients
• Low-dose brachytherapy (LDB) – 151 patients
• Focal bipolar radiofrequency ablation (FBRA) – 10 patients
• Transurethral ultrasound ablation (TULSA) – 22 patients.

Regarding what the research team discovered, there’s bad news and good news. The bad news stems from a lack of standardized study design and protocol. As the authors point out, there was “significant variability” in focal therapy technologies/methods, the treatment strategy (focal vs. hemigland vs. zonal), and outcome assessment methods.” This is a universal flaw that occurs when study centers design their own protocol. As the authors experienced, it makes gathering and comparing apples-to-apples data nearly impossible, let alone drawing accurate conclusions.

In fact, more than 11 years ago I posted a blog about experts trying to reach consensus on designing focal therapy studies.^[ii] Based on my own journal reading, it appears to me that the work of those experts back then never caught on, since I have yet to see even two studies with identical design. As is the case for the current paper, the authors had limited ability to generate meaningful numbers other than a broad observation: Focal therapy offers better preservation of sexual function at 12 months than radical treatment. If Cynic Diogenes were alive, he would probably say, “Duh.”

Well, Diogenes aside, here’s the good news for PCa patients considering a focal treatment. Given that the authors represent the future of treatment options, they have arrived at a rosy conclusion. To quote them, focal therapy “offers a promising balance between oncologic control and functional preservation in low- to intermediate-risk PCa.”  

The Sperling Prostate Center is proud to offer experience and excellence in two focal therapies, Focal Laser Ablation and TULSA. For more information, please contact us.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Piramide F, Veccia A, Tzelves L, Nikles S et al. Sexual function outcomes in men undergoing minimal invasive ablative techniques for prostate cancer: a ESRU/YAU urotech systematic review and pooled analysis. Minerva Urol Nephrol. 2025 Jun;77(3):285-297. 
[ii] van den Bos W, Muller BG, Ahmed H, Bangma CH et al. Focal therapy in prostate cancer: international multidisciplinary consensus on trial design. Eur Urol. 2014 Jun;65(6):1078-83.