How to cite: Sanchez-Salas R. Focal therapy for localized prostate cancer: why hasn’t it become the standard of care? September 15, 2025. Accessed January 2026. https://grandroundsinurology.com/focal-therapy-for-localized-prostate-cancer-why-hasnt-it-become-the-standard-of-care/
Summary
Rafael Sanchez-Salas, MD, Associate Professor, Department of Surgery, Division of Urology, McGill University, Montreal, Canada, examines why focal therapy for localized prostate cancer has not yet become the standard of care, despite promising data and increasing research interest. He emphasizes that focal therapy aims to achieve oncologic control while reducing treatment-related morbidity compared to radical therapies, and suggests that focal therapy could be particularly relevant for patients with intermediate-risk localized disease.
Dr. Sanchez-Salas addresses the limitations of focal therapy, including a lack of long-term oncological outcome data, heterogeneity in patient selection, and the absence of standardized treatment protocols. He also discussed variability in imaging interpretation, notably in magnetic resonance imaging (MRI).
Dr. Sanchez-Salas highlights ongoing studies that may clarify patient selection criteria and long-term results. He stresses that successful integration of focal therapy requires not only robust clinical evidence but also consensus among urologists, radiologists, and oncologists. He notes that patient preference and demand are growing, particularly given the potential for preservation of quality of life.
Dr. Sanchez-Salas asserts that focal therapy remains an evolving strategy. While it may not yet be the standard of care, it represents a meaningful option for select patients and will likely play a larger role as evidence and consensus grow.
The Global Summit on Precision Diagnosis and Treatment of Prostate Cancer is a unique multi-disciplinary forum organized to inform the key health care stakeholders about the emerging advances in clinical case and research and create a consensus-based vision for the future of precision care and educational and research strategy for its realization. The mission of the Summit is to fill the currently existing gap between the key experts of in vivo imaging, the world authorities in the in vitro fluid- and tissue-based molecular diagnostics, including genomics, and thought leaders in the development of novel observation strategies (e.g., active surveillance, or AS) and therapeutic interventions.
ABOUT THE AUTHOR
Rafael Sanchez-Salas, MD, is the Stephen Jarislowsky Chair of Urology and Associate Professor in the Urology Division of the Department of Surgery at McGill University in Montreal, Canada. Dr. Sanchez-Salas is an established leader in the field of focal therapy for the treatment of localized prostate cancer. His current research priorities include diagnosis and treatment of localized prostate cancer with emphasis on focal therapy for prostate cancer and its impact on prostatic microenvironment and outcomes.
Dr. Sanchez-Salas graduated valedictorian with his medical degree from the Universidad de los Andes in Mérida, Venezuela. He completed his basic surgical and urological training at Universidad Central in Caracas, Venezuela. He was awarded with scholarships from Confederacion Americana de Urologia and The European Association of Urology to pursue fellowship training in urological oncology and minimally invasive urological surgery at Memorial Sloan Kettering Cancer Center in New York, Clinica Santa Maria in Chile, and L’Institut Mutualiste Montsouris in France.
After fellowship training, Dr. Sanchez-Salas joined the faculty of the Department of Urology at L’Institut Mutualiste Montsouris in Paris, France. During his time in Paris, Dr. Sanchez-Salas worked extensively on robotic surgery and the development of partial gland ablation for Prostate Cancer treatment. He was responsible for the fellowship program organization at L’Institut Mutualiste Montsouris and he actively participated in the mentoring and training of a number of young urological surgeons. Dr. Sanchez-Salas has authored over 200 indexed scientific papers.He is a member of theEditorial Board for European Urology Focus, The Journal of Endourology Part B, Videourology,andActas Españolas de Urologia. Dr. Sanchez-Salas chaired the SIU-International Consultation on Urological Disease on image-guided therapy for Prostate and Renal Carcinomas in 2015.
