Michael Rothberg, MD

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.