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How to cite: Frizzell BA. Focal therapy for metastatic disease in prostate cancer. October 2025. Accessed January 2026. https://grandroundsinurology.com/focal-therapy-for-metastatic-disease-in-prostate-cancer/
Summary
Bart A. Frizzell, MD, Clinical Associate Professor, Radiation Oncology and Urology, Wake Forest University, Winston-Salem, North Carolina, presents an overview of how focal radiation therapy is being explored for the treatment of metastatic prostate cancer, emphasizing how concepts once considered unlikely have gained traction as supporting evidence grows. He frames the discussion around a “phase” structure to explain how early studies introduced the concept of metastasis-directed therapy, and how more recent work aims to clarify potential benefits and identify the patient groups most likely to be affected.
Dr. Frizzell notes that current research supports focal therapy in metastatic settings. He describes how the field has progressed from the introduction of focal therapy concepts to efforts aimed at clarifying treatment roles and responsibilities. He outlines that some studies suggest a potential benefit to adding focal radiation in men with limited metastatic disease, though the specific value remains difficult to define due to differences in study design and small sample sizes.
Dr. Frizell also highlights distinctions in metastatic burden, emphasizing that disease site and the number of involved areas influence outcomes. He explains how definitions of high versus low volume disease shape eligibility criteria in many studies of intact-prostate treatment and metastasis-directed approaches. Dr. Frizzell describes early trials as providing signals of possible value and characterizes newer trials as beginning to show more consistent patterns of response and disease control, particularly as measured by PSA changes or progression-free intervals. He expresses optimism that upcoming research will clarify patient selection, treatment sequencing, and the integration of systemic and focal therapies.
About The 12th Urology Today Conference:
Presented by chair Ryan P. Terlecki, MD, FACS, the 12th Urology Today conference was designed to keep urologists, urologic oncologists, and other healthcare providers educated on the most pertinent issues in urology practices. Areas of focus included urologic oncology, men’s health and reconstruction, female urology, pediatric urology, kidney stones and related conditions, and methods of providing the best care amidst the required logistics of the business side of medicine.
For further educational activities from this conference, visit our collection page.
