FOCAL THERAPY OF PROSTATE AND KIDNEY CANCER: Edited by Jean de la Rosette and Thomas J. PolascikRetreatment after focal therapy for failure a bridge too far?Soria, Francescoa,b; Marra, Giancarlob; Allasia, Marcob; Gontero, PaolobAuthor Information aDepartment of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria bDivision of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy Correspondence to Francesco Soria, Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria. E-mail: [email protected] Current Opinion in Urology: November 2018 - Volume 28 - Issue 6 - p 544-549 doi: 10.1097/MOU.0000000000000536 Buy Metrics Abstract Purpose of review To summarize the current knowledge about the evaluation of disease persistence and recurrence after focal therapy ablation (FTA) for small renal masses and to assess the outcomes and complications of related treatment options. Recent findings FTA procedures continuously increased over the last 20 years, being now performed in more than one on 10 patients with T1a renal cell carcinoma. Disease recurrence seems to occur more often following radiofrequency ablation (RFA) compared with cryoablation. Evidence about the management of disease recurrence is scarce. Treatment options are similar to those available for de novo renal cell carcinomas, and include reablation, partial or radical nephrectomy and observation. Reablation is feasible, safe and can be easily done in the majority of cases. Oncological outcomes of repeated ablation, although encouraging, remain mostly uninvestigated and unreported. Summary In case of disease persistence or recurrence after FTA, observation may be an acceptable approach, reserving repeated ablation or surgery only in those exhibiting significant tumor growth. In these patients repeated ablation with RFA is safe and noninvasive. Surgery after FTA presents technical difficulties related to perinephric scarring, especially with regards to nephron-sparing surgery. This should be taken into consideration in patients’ counseling as well as in decision-making process. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.