Half of prostate focal therapy patients fall outside guideline recommendations

Clinical takeaway: Patient selection is critical when considering focal therapy for prostate cancer. Low-risk patients may be better served by active surveillance, while high- and very high-risk disease may require more aggressive treatment.

Focal therapy has emerged as a less invasive option for some men with prostate cancer, targeting only the cancerous portion of the prostate rather than treating or removing the entire gland. The goal is to control cancer while reducing urinary and sexual side effects associated with surgery or radiation. But despite growing adoption, the approach is frequently being used outside the patient groups supported by current guidelines.

Researchers analyzed National Cancer Database records for nearly 1.18 million men aged 50 years or older with nonmetastatic prostate cancer diagnosed from 2010 through 2023. Focal therapy remained uncommon overall, but among the 15,672 patients who received it, about half had either low-risk or high- to very high-risk disease. Current guidelines do not support the approach in these risk groups.

Why focal therapy may be inappropriate differs by risk group. For men with low-risk prostate cancer, focal therapy may represent unnecessary treatment when active surveillance can often safely avoid or delay treatment-related harms. At the other end of the spectrum, patients with high- or very high-risk disease may need more aggressive therapies backed by stronger evidence for long-term cancer control.

The findings are particularly relevant because focal therapy itself remains an evolving approach with limited long-term comparative evidence. In an accompanying JAMA editorial, experts cautioned against allowing its growing availability to outpace the evidence, emphasizing that questions remain about long-term cancer control, retreatment, and how patients should be monitored after treatment.

“Innovation is critical in prostate cancer care,” said senior study author Quoc-Dien Trinh, MD, MBA, of the University of Pittsburgh School of Medicine. “Our findings highlight the need to ensure that promising new treatments are adopted in ways that are supported by evidence and matched to the patients most likely to benefit.”

Source: Cosenza A, et al. (2026 Aug 13) JAMA. Focal therapy for prostate cancer