Michael Rothberg, MD, presented “Point Counterpoint: Is Focal Therapy Ready for Prime Time (No)” during the 2024 Frontiers in Oncologic Prostate Care and Ablative Local Therapy symposium on October 17, 2024, in San Diego, California.
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How to cite: Rothberg, Michael. “Point Counterpoint: Is Focal Therapy Ready for Prime Time (No).” October, 2024. Accessed Jan 2025. https://grandroundsinurology.com/point-counterpoint-is-focal-therapy-ready-for-prime-time-no/
Point Counterpoint: Is Focal Therapy Ready for Prime Time (No) – Summary
Michael Rothberg, MD, critically examines whether focal therapy for prostate cancer is ready for widespread clinical adoption, emphasizing the need for rigorous evaluation. The 10-minute discussion highlights prostate cancer’s biological complexity, including its multifocal and heterogeneous nature, which challenges the premise of focal therapy targeting the “index lesion.”
Dr. Rothberg underscores significant limitations in current diagnostic tools, particularly MRI and biopsy techniques. Imaging inconsistencies and operator variability reduce the reliability of identifying clinically significant lesions.
Current guidelines from leading organizations like NCCN and AUA do not endorse focal therapy as a standard treatment due to insufficient high-level evidence. Dr. Rothberg cites the lack of randomized controlled trials comparing focal therapy to whole-gland treatments, which leaves gaps in understanding survival and recurrence rates beyond medium-term follow-ups.
Frontiers in Oncologic Prostate Care and Ablative Local Therapy (FOCAL) is an outstanding program on prostate imaging, transperineal interventions, and ablative treatments for prostate cancer and benign prostatic hyperplasia. Bringing together community-based, academic, and industry partners, FOCAL offers lectures by world-renowned faculty and hands-on training workshops on in-office transperineal interventions, fusion-guided prostate ablation and state-of-the-art BPH management with novel technologies.
