***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The comparative effectiveness of treatments for prostate cancer that is detected by prostate-specific antigen ( PSA ) testing remains uncertain . METHODS We compared active monitoring , radical prostatectomy , and external-beam radiotherapy for the treatment of clinical ly localized prostate cancer . Between 1999 and 2009 , a total of 82,429 men 50 to 69 years of age received a PSA test ; 2664 received a diagnosis of localized prostate cancer , and 1643 agreed to undergo r and omization to active monitoring ( 545 men ) , surgery ( 553 ) , or radiotherapy ( 545 ) . The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up . Secondary outcomes included the rates of disease progression , metastases , and all-cause deaths . RESULTS There were 17 prostate-cancer-specific deaths overall : 8 in the active-monitoring group ( 1.5 deaths per 1000 person-years ; 95 % confidence interval [ CI ] , 0.7 to 3.0 ) , 5 in the surgery group ( 0.9 per 1000 person-years ; 95 % CI , 0.4 to 2.2 ) , and 4 in the radiotherapy group ( 0.7 per 1000 person-years ; 95 % CI , 0.3 to 2.0 ) ; the difference among the groups was not significant ( P=0.48 for the overall comparison ) . In addition , no significant difference was seen among the groups in the number of deaths from any cause ( 169 deaths overall ; P=0.87 for the comparison among the three groups ) . Metastases developed in more men in the active-monitoring group ( 33 men ; 6.3 events per 1000 person-years ; 95 % CI , 4.5 to 8.8 ) than in the surgery group ( 13 men ; 2.4 per 1000 person-years ; 95 % CI , 1.4 to 4.2 ) or the radiotherapy group ( 16 men ; 3.0 per 1000 person-years ; 95 % CI , 1.9 to 4.9 ) ( P=0.004 for the overall comparison ) . Higher rates of disease progression were seen in the active-monitoring group ( 112 men ; 22.9 events per 1000 person-years ; 95 % CI , 19.0 to 27.5 ) than in the surgery group ( 46 men ; 8.9 events per 1000 person-years ; 95 % CI , 6.7 to 11.9 ) or the radiotherapy group ( 46 men ; 9.0 events per 1000 person-years ; 95 % CI , 6.7 to 12.0 ) ( P<0.001 for the overall comparison ) . CONCLUSIONS At a median of 10 years , prostate-cancer-specific mortality was low irrespective of the treatment assigned , with no significant difference among treatments . Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring . ( Funded by the National Institute for Health Research ; ProtecT Current Controlled Trials number , IS RCT N20141297 ; Clinical Trials.gov number , NCT02044172 . ) Background : Contemporary screening for prostate cancer frequently identifies small volume , low- grade lesions . Some clinicians have advocated focal prostatic ablation as an alternative to more aggressive interventions to manage these lesions . To identify which patients might benefit from focal ablative techniques , we analysed the surgical specimens of a large sample of population -detected men undergoing radical prostatectomy  as part of a r and omised clinical trial . Methods : Surgical specimens from 525 men who underwent prostatectomy within the ProtecT study were analysed to determine tumour volume , location and grade . These findings were compared with information available in the biopsy specimen to examine whether focal therapy could be provided appropriately . Results : Solitary cancers were found in prostatectomy specimens from 19 % ( 100 out of 525 ) of men . In addition , 73 out of 425 ( 17 % ) men had multiple cancers with a solitary significant tumour focus . Thus , 173 out of 525 ( 33 % ) men had tumours potentially suitable for focal therapy . The majority of these were small , well-differentiated lesions that appeared to be pathologically insignificant ( 38–66 % ) . Criteria used to select patients for focal prostatic ablation underestimated the cancer 's significance in 26 % ( 34 out of 130 ) of men and result ed in overtreatment in more than half . Only 18 % ( 24 out of 130 ) of men presumed eligible for focal therapy , actually had significant solitary lesions . Conclusion : Focal therapy appears inappropriate for the majority of men presenting with prostate-specific antigen-detected localised prostate cancer . Unifocal prostate cancers suitable for focal ablation are difficult to identify pre-operatively using biopsy alone . Most lesions meeting criteria for focal ablation were either more aggressive than expected or posed little threat of progression INTRODUCTION Focal therapy for localized prostate cancer has the potential for oncological control without the side effects of radical therapies . However , there is currently no vali date d method for monitoring treatment success . We assessed the diagnostic performance of prostate-specific antigen ( PSA ) parameters and MRI compared to histological outcomes following focal therapy . PATIENTS AND METHODS Patients from 3 Ethics Review Board approved prospect i ve studies of focal high intensity-focused ultrasound ( HIFU ) ( Sonablate 500 ) for localized prostate cancer ( T1c-T3a , Gleason grade ≤4 + 3 , and PSA≤20 ) .  Post-HIFU PSA nadir , 6-month PSA , PSA density , and early ( < 3wk ) and late ( 6mo ) MRI ( T2-weighted , dynamic contrast-enhanced±diffusion-weighted ) was assessed for predictive accuracy of cancer on postoperative biopsy , using receiver operating characteristic ( ROC ) analysis and sensitivity , specificity , and positive and negative predictive estimates . ROC areas for MRI and PSA were compared . Calculations for statistical significance ( P≤0.05 ) were obtained in a subset of patients comparing area under ROC for 6-month MRI and PSA criteria , across 4 different histological definitions of disease significance . RESULTS Of 118 men , 111 underwent at least 1 postoperative biopsy ( median 6 cores ) , with an overall positive biopsy rate of 37 % ( 41/118 ) , over a mean follow-up period of 716 days post-HIFU . Areas under ROC for early and late MRI were ( depending on definition of significant disease ) 0.65 to 0.76 and 0.77 to 0.85 , respectively , with sensitivity , specificity , and negative predictive values of 68 % to 91 % , 52 % to 55 % , and 85 % to 98 % ( early MRI ) , and 63 % to 80 % , 67 % to 73 % , and 86 % to 97 % ( late MRI ) . The area under the ROC curve was statistically significantly higher for late MRI than 6 months and nadir PSA for residual disease > 3 mm or any Gleason 4 tumor . CONCLUSIONS Early and late MRI performed better than PSA measurements in the detection of residual tumor after focal therapy Purpose The design , conduct and completion of r and omized trials for curative prostate cancer ( PCa ) treatments are challenging . To evaluate the effect of robot-assisted radical prostatectomy ( RARP ) versus focal irreversible electroporation ( IRE ) on patient-reported quality of life ( QoL ) and early oncological control using propensity-scored matching . Methods Patients with T1c – cT2b significant PCa ( high-volume ISUP 1 or any 2/3 ) who received unifocal IRE were pair-matched to patients who received nerve-sparing RARP .  Patient-reported outcomes were prospect ively assessed using the Exp and ed Prostate Cancer Index Composite ( EPIC ) , AUA symptom score and Short Form of Health Survey ( SF-12 ) physical and mental components . Oncological failure was defined as biochemical recurrence ( RARP ) or positive follow-up biopsies ( IRE ) . Generalized mixed-effect models were used to compare IRE and RARP . Results 50 IRE patients were matched to 50 RARP patients by propensity score . IRE was significantly superior to RARP in preserving pad-free continence ( UC ) and erections sufficient for intercourse ( ESI ) . The absolute differences were 44 , 21 , 13 , 14 % for UC and 32 , 46 , 27 , 22 % for ESI at 1.5 , 3 , 6 , and 12 months , respectively . The EPIC summary scores showed no statistically significant differences . Urinary symptoms were reduced for IRE and RARP patients at 12 months , although IRE patient initially had more complaints . IRE patients experienced more early oncological failure than RARP patients . Conclusions These data demonstrated the superior preservation of UC and ESI with IRE compared to RARP up to 12 months after treatment . Long-term oncological data are warranted to provide ultimate proof for or against focal therapy Purpose : We evaluated focal therapy with high intensity focused ultrasound hemiablation in a prospect i ve trial . Material s and Methods : We performed a prospect i ve , multicenter , single arm study in patients with unilateral low/intermediate risk prostate cancer who were treated from April 2013 through March 2016 in Germany in AUO ( Arbeitsgemeinschaft Urologische Onkologie ) Study Protocol AP 68/11 . Unilateral prostate cancer was assessed by transrectal ultrasound guided biopsy and multiparametric magnetic resonance imaging . Hemiablation was done using the Ablatherm ® or the Focal One ® device . The oncologic outcome was assessed by the salvage treatment rate , multiparametric magnetic resonance imaging and rebiopsy at 12 months . Functional outcome , quality of life , anxiety and depression were measured by vali date d question naires at baseline and every 3 months . Results : Of the 54 recruited patients 51 completed 12‐month or greater visits . Mean ± SD followup was 17.4 ± 4.5 months . Mean prostate specific antigen decreased from 6.2 ± 2.0 to 2.9 ± 1.9 ng/ml at 12 months ( p < 0.001 ) . Biopsy at 12 months was positive for any prostate cancer and for clinical ly significant prostate cancer in 13 ( 26.5 % ) and 4 ( 8.2 % ) of the 49 patients , respectively . Posttreatment multiparametric magnetic resonance imaging had limited 25 % sensitivity for clinical ly significant prostate cancer . Ten patients ( 19.6 % ) underwent salvage treatment . Potency was maintained in 21 of the 30 men who were potent preoperatively . There was no increase in incontinence . Quality of life , anxiety and depression did not change postoperatively . The study was limited by a short followup and the lack of a control arm . Conclusions : Focal therapy hemiablation is safe with little alteration of functional outcome . The oncologic outcome is acceptable on short‐term followup . Followup multiparametric magnetic resonance imaging performed poorly and should not replace repeat biopsy . Focal therapy has no impact on posttreatment anxiety and depression Purpose To report the safety profile and 2-year functional outcomes of in-bore magnetic resonance (MR)-guided focused ultrasound on single cancer foci in men with prostate cancer . Material s and Methods Ethics approval was obtained from the central ized institutional review board for this prospect i ve single-arm study , and patients provided informed consent . Patients with untreated low-volume low- grade prostate cancer ( clinical stage T2a or lower ; Gleason score , 3 + 3 ; index tumor ≤10 mm3 ) underwent MR-guided focused ultrasound between July 2011 and February 2013 . All patients underwent robotic transperineal mapping biopsy and multiparametric MR imaging .  Only those with a maximum of two lesions smaller than 10 mm at mapping biopsy were included . Target areas were sonicated with real-time MR thermometry monitoring , excluding critical areas from the beam path . Serum prostate-specific antigen ( PSA ) and Exp and ed Prostate Index Composite ( EPIC ) scores were obtained at baseline and at 1 , 3 , 6 , 12 , 18 , and 24 months and were plotted to observe their trend . Mean EPIC subdomain score changes at each serial time point were compared with the baseline score by using paired t tests ( level of significance , P < .007 ) . Repeat transperineal biopsy was performed at 6 and 24 months . Results Fourteen men ( mean age , 62.8 years ; median PSA level , 8.3 ng/mL ) underwent treatment , with 12 men completing 2-year follow-up .  A median reduction of PSA level by 2.9 ng/mL was observed at 6 months . Seven men had Clavien-Dindo grade 1 - 2 complications . There was a slight insignificant deterioration of EPIC urinary symptom score ( mean increase of 7.8 points compared with baseline , P = 
    Output:
    
Recent findings Focal therapy reduces the rate of cancer progression and conversion to radical therapy in men on active surveillance for prostate cancer .
Although long-term oncological outcomes remain lacking , focal therapy has a low complication rate , minimal impact on urinary continence and a moderate impact on erectile function .
Summary With the appropriate expertise in imaging , targeted biopsy and targeted ablation , focal therapy is a good option in men with low – intermediate risk cancer who are willing to maximize their urinary and sexual function .