How to cite: Sonn, G. “Focal Therapy Patient Selection: Urologist Perspective.” September 15, 2025. Accessed Oct 2026. https://grandroundsinurology.com/focal-therapy-patient-selection-urologic-perspective
Summary
Geoffrey Sonn, MD, Associate Professor of Urology and Radiology, Stanford University School of Medicine, Stanford, California, emphasizes that patient selection for focal therapy remains one of the most important and debated aspects of its implementation. He noted that focal therapy aims to balance oncologic control with preservation of urinary and sexual function, but careful criteria must be applied.
Dr. Sonn outlines that imaging, particularly multiparametric magnetic resonance imaging (mpMRI), has improved the ability to localize clinically significant prostate cancer. However, he underscores that mpMRI is not perfect, and targeted plus systematic biopsy remains necessary to confirm eligibility. He further notes that uncertainty exists regarding the thresholds for tumor volume, Gleason score, and multifocality when considering focal therapy.
Dr. Sonn asserts that focal therapy may be most appropriate for patients with unilateral, clinically significant disease confirmed by imaging and biopsy. He acknowledges that long-term oncologic outcomes are still being established. He also discusses the role of novel imaging modalities and biomarkers as potential tools for improving selection in the future.
Dr. Sonn argues that focal therapy is promising but should be pursued in carefully selected patients, with continued evaluation of functional and oncologic outcomes.
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
Geoffrey Sonn, MD, is an Associate Professor of Urology at Stanford University in California. Dr. Sonn’s research interests include cancer imaging, MRI-Ultrasound fusion targeted prostate biopsy, prostate cancer focal therapy, robotic surgery for prostate and kidney cancer, and developing artificial intelligence methods to improve prostate cancer detection on MRI and ultrasound. He was the Stanford principal investigator of a major clinical trial using MRI-guided focused ultrasound to treat prostate cancer.
