How to cite: Crouzet S. “Focal Therapy vs Radical Treatment for Prostate Cancer.” October, 2025. Accessed Mar 2026. https://grandroundsinurology.com/focal-therapy-vs-radical-treatment-for-prostate-cancer/
Summary
Sébastien Crouzet, MD, PhD, Associate Professor, Urology Department, Edouard Herriot Hospital, Claude Bernard University, Lyon, France, reviews multiple levels of evidence comparing focal high-intensity focused ultrasound (HIFU) or subtotal whole-gland HIFU with radical prostatectomy. He begins with the French national trial comparing HIFU to radical prostatectomy. After age-adjusted analysis, HIFU was considered non-inferior to salvage therapy.
He then presents matched pair studies comparing focal HIFU with robotic prostatectomy. In a Lyon study with a one-year follow-up, the trifecta favoured HIFU, with better quality of life in terms of continence and erectile function. A Belgian matched analysis with a 36-month follow-up also showed shorter hospital stays and improved continence and potency after HIFU, while maintaining similar oncologic outcomes at three years.
He describes the FARP randomized trial from Oslo, which compares focal HIFU with radical prostatectomy in unilateral clinically significant cancer. Functional results again favour HIFU, including substantially lower rates of incontinence and improved erectile function. Early oncologic outcomes at three years show no difference between groups.
He summarises two additional randomised studies. HIFUSA examines focal HIFU versus active surveillance in patients with visible Gleason 6 lesions and shows a 50 percent reduction in additional radical treatment after focal therapy. EMERHIT is a medico-economic trial comparing focal HIFU with prostatectomy in intermediate risk disease to evaluate functional outcomes, oncologic outcomes, and cost. This study is still recruiting.
Dr. Crouzet emphasizes that focal HIFU provides superior functional outcomes and similar short-term oncologic outcomes in selected patients. Ongoing randomised and economic studies will continue to define its place in prostate cancer management.
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.
ABOUT THE AUTHOR
Sebastien Crouzet, MD, PhD, is an Associate Professor of Urology at the University of Lyon in France. Dr. Crouzet specializes in minimally invasive surgery, robotic surgery, focal therapy of prostate cancer, and high-intensity focused ultrasound.
