Focal Therapy for Prostate Cancer: Evidence-Based or Oversold?

In 2013, a prostate-specific antigen blood test revealed that Richard LaFrate's levels had jumped.Guidelines now recommend active surveillance for patients like LaFrate, who have low-risk disease. This strategy would mean monitoring the cancer until LaFrate required treatment, with the upside being he might never need therapy.

LaFrate's urologist asked him to pay $25,000 out-of-pocket to undergo the focal procedure at a clinic in the Bahamas. LaFrate refused and, ultimately, landed on active surveillance as the best strategy to manage for his low-risk disease.Over the past 10 years, the popularity of focal therapy has grown among men with intermediate-risk prostate cancer — Gleason 3+4 tumors — as an alternative to invasive surgery and active surveillance.

Spratt has seen hundreds of patients after focal therapy, some from prominent centers, who have emptied their bank accounts to undergo treatment with the promise of great results and ultimately felt misled when the cancer has recurred. In the United States, focal therapy has become an attractive option for men with prostate cancer who want to avoid radiation or radicalBut the excitement surrounding the use of focal therapy in prostate cancer has outpaced broader acceptance.

When patients see Spratt after a recurrence, he informs them that their side effects will be worse if he gives them radiation or surgery now vs if he had given them curative therapy upfront. "But this is what we're left with," he tells them. But Shoag has a different take on the trajectory of focal therapy research and care in the United States.

Although it's not clear how many men in the United States are receiving focal therapy who shouldn't, even proponents of focal therapy, like George, have expressed concern.

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