Renal & Urology NewsHalf of Prostate Cancer Focal Therapy Cases Were Inappropriate

ℹ️ Observational Association Only Evidence

Focal therapy has emerged as a less invasive treatment approach for localized prostate cancer, yet evidence supporting its routine use remains limited. Current guidelines generally restrict focal therapy in intermediate-risk disease to clinical trials or prospective registries and do not endorse routine use in low-, high-, or very high-risk disease due to a lack of level 1 evidence. Investigators analyzed National Cancer Database records from 2010 through 2023 to evaluate contemporary focal therapy utilization patterns among more than 1.17 million men aged 50 years or older with nonmetastatic prostate cancer. The study sought to determine whether focal therapy adoption aligned with evidence-based recommendations and how treatment patterns changed over time.

Clinical Considerations

• Among 15,672 patients receiving focal therapy, approximately 51% were treated outside guideline-supported risk categories.
• Focal therapy utilization increased among patients with favorable intermediate-risk disease from 2.1% to 2.9%.
• Use declined among high-risk disease (2.1% to 0.9%) and very high-risk disease (1.8% to 0.5%), suggesting some movement toward risk-based selection.
• Investigators could not determine whether intermediate-risk patients received treatment within trials or registries because these data are not captured in the NCDB.
• Patients with older age, greater comorbidity burden, nonprivate insurance, and treatment at nonacademic or higher-volume facilities had a higher adjusted probability of receiving focal therapy.
• Treatment approaches shifted substantially, with declining cryotherapy use and increasing utilization of laser ablation and high-intensity focused ultrasound (HIFU).

Practice Applications

• Recognize that current evidence supporting focal therapy remains limited outside investigational settings.
• Review patient risk classification carefully before considering focal therapy as a treatment strategy.
• Discuss evidence limitations, uncertainty regarding long-term oncologic outcomes, and potential alternatives during shared decision-making.
• Interpret utilization trends separately from treatment effectiveness because this study evaluated practice patterns rather than clinical outcomes.
• Monitor ongoing prospective trials and registry data that may clarify the role of focal therapy in localized prostate cancer management.