Focal Therapy for Prostate Cancer Remains Rare — and Often Used Inappropriately, Study Finds

Focal therapy, a treatment that targets only the tumor rather than the whole prostate, remains rare for nonmetastatic prostate cancer in the United States, and its use was considered inappropriate in about half of the patients who received it, according to a research letter published in the journal JAMA.

Researchers led by Dr. Andrea Cosenza of the University of Pittsburgh Medical Center used the National Cancer Database to study patterns of focal therapy use among 1,179,384 U.S. patients aged 50 and older diagnosed with nonmetastatic prostate cancer between 2010 and 2023. Focal therapy use was defined as inappropriate for patients with low-, high- or very-high-risk disease, where treating the whole prostate or the whole body is usually recommended instead.

Overall, only 1.3% of patients received focal therapy. Of those who did, 51.0% had low-, high- or very-high-risk disease — an inappropriate use by the study's definition — while 49.0% had intermediate-risk disease.

Trends over time varied by risk group. Focal therapy use in low-risk disease did not change significantly, moving from 1.8% to 2.2%. It rose significantly in favorable intermediate-risk disease, from 2.1% to 2.9%, but fell in unfavorable intermediate-risk disease, from 2.5% to 1.9%, in high-risk disease, from 2.1% to 0.9%, and in very-high-risk disease, from 1.8% to 0.5%.

Senior author Dr. Quoc-Dien Trinh, also of the University of Pittsburgh Medical Center, said the findings highlight the need to ensure that promising new treatments are adopted in ways supported by evidence and matched to the patients most likely to benefit.