Prostate focal therapy mismatch found in half of US patients

A national analysis published in JAMA reveals that approximately 51 percent of men receiving focal therapy for prostate cancer in the United States fall outside the risk groups currently supported by clinical guidelines.

Focal therapy, which uses heat, cold, or laser energy to target only the cancerous portion of the prostate, aims to preserve urinary and sexual function. However, researchers from the University of Pittsburgh found a significant mismatch between patient profiles and recommended usage. Among the 15,672 men who received the procedure between 2010 and 2023, nearly half had low, high, or very high-risk disease.

Guidelines from the American Urological Association (AUA) and the American Society for Radiation Oncology (ASTRO) suggest that focal therapy is investigational for low- and intermediate-risk disease due to a lack of high-quality comparative data. For high-risk disease, guidelines state clinicians should not recommend focal ablation outside of clinical trials, as targeted treatment may leave cancer behind. Conversely, treating low-risk patients may expose them to procedure risks without a demonstrated survival benefit.