Focal therapy offers a middle-ground approach between active surveillance and more aggressive treatments like radical prostatectomy or whole-gland radiation. While it holds great promise for many patients, it also comes with important considerations. Below is a balanced summary:

Pros

·         Minimally Invasive: Most focal therapies are outpatient procedures, often performed without incisions and with shorter recovery time than surgery or radiation.

·         Preservation of Function: By sparing the untreated parts of the prostate, focal therapy aims

·         Repeatable: If cancer recurs, focal therapy can often be repeated, or other treatments (like radiation or surgery) can still be pursued.

·         Personalized and Targeted: Treatment is based on the specific location of the tumor seen on MRI and biopsy, allowing a tailored approach for each patient.

·         Psychological Benefits over Active Surveillance: For some patients, focal therapy offers peace of mind by actively treating cancer while avoiding overtreatment.

·         Supports Patient Autonomy: Offers an alternative for patients who want to be proactive but are not ready to commit to life-altering treatments.

·         Emerging Access to Clinical Trials: Increasing availability of clinical trials offers patients early access to advanced technologies and follow-up protocols that may improve outcomes.

Cons

·         Limited Long-Term Data: Since focal therapy is relatively new, long-term cancer control outcomes are still under investigation, especially for intermediate-risk disease.

·         Requires Rigorous Follow-Up: Ongoing monitoring with PSA testing, imaging, and repeat biopsies is critical due to the risk of missed or recurrent disease.

·         Residual Prostate Tissue: As the entire gland is not removed or treated, PSA levels can remain detectable, making interpretation more complex.

·         MRI and Biopsy Dependent: Accurate targeting relies on high-quality MRI and expert interpretation; not all centers are equally equipped.

·         Not Suitable for All Tumor Types: Multifocal, high-grade, or MRI-invisible cancers may not be appropriate for focal therapy.

·         Insurance and Access: Not all insurance plans may cover focal therapy, and access may be limited to specialized centers or academic institutions.

Bottom Line

Focal therapy is an evolving, patient-centered treatment option that bridges the gap between monitoring and definitive therapy. At the University of Miami, we offer several focal therapy modalities and participate in ongoing clinical trials to ensure patients have access to the latest innovations. For the right candidate, it provides a way to address prostate cancer with precision, fewer side effects, and greater control over treatment decisions.