• Herbert Lepor
    Address correspondence to: Herbert Lepor, M.D., NYU School of Medicine, Chief, Urology NYU Langone Health, 222 East 41st Street, 12th floor, New York, NY 10017
    Martin Spatz Chair, Department of Urology, NYU Langone Health, New York, NY 10017
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      We appreciate and fully endorse the thoughtful editorial comments. All treatments for prostate cancer balance oncological control and adverse events. Should we preserve the neurovascular bundle and maximize membranous urethral length to maximize erectile function and continence, respectively? Should we perform an extensive lymphadenectomy to maximize oncological control? What is the optimal radiation dose? Should we offer adjuvant androgen deprivation therapy and if so, for how long in candidates for radiation therapy? As highlighted in the editorial comment, focal ablation also has its risk-benefit conundrums related to extent of ablation. Should the ablation be extended beyond the capsule and risk injury to the neurovascular bundle? Should the ablation extend to the extreme apex and risk stricture formation? Should the ablation be extended to the “benign” transition zone in order to improve lower urinary tract symptoms? Finally, will extending the ablation decrease the risk of disease recurrence while rendering secondary radical prostatectomy more technically challenging? All of these treatment planning decisions are made without knowing the true extent of the index lesion and precision of energy delivery.
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