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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Disclosure: No conflict of interest
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© 2021 Published by Elsevier Inc.
