How to cite: Lepor H. My Journey to Focal Therapy of Prostate Cancer. Grand Rounds in Urology. February 2026. Accessed Oct 2026. https://grandroundsinurology.com/my-journey-to-focal-therapy-of-prostate-cancer/
Summary
Herbert Lepor, MD, Martin Spatz Chairman of Urology, NYU Langone Health, New York, New York, presents a personal and institutional perspective on the evolution of focal therapy for prostate cancer. Dr. Lepor frames focal therapy as an effort to address limitations of radical prostatectomy, particularly urinary incontinence, sexual dysfunction, treatment-related morbidity, and overtreatment in appropriately selected men with focal disease. He reviews the rationale for focal therapy, which depends on reliable identification of index lesions, low rates of clinically significant out-of-field disease, and preservation of oncologic control while prioritizing quality of life.
Dr. Lepor discusses outcomes from a prospective focal cryoablation cohort, highlighting five-year estimates of freedom from clinically significant recurrence, in-field control, out-of-field control, and freedom from failure, while emphasizing rigorous longitudinal surveillance with prostate-specific antigen (PSA) monitoring, multiparametric magnetic resonance imaging (MRI), and for-cause biopsy based on suspicious imaging or PSA kinetics. Consecutive PSA rises greater than 0.5 ng/mL are identified as a potential predictor of recurrence risk.
Dr. Lepor also reviews evidence supporting reduced routine biopsy when surveillance MRI is negative, based on low rates of clinically significant recurrence in that setting. Functional outcomes are presented as a major component of treatment selection, including the absence of incontinence in the reported cohort, improvement in lower urinary tract symptoms for selected men, and high rates of potency preservation, while noting that men with moderate baseline erectile dysfunction may remain more vulnerable to decline.
Dr. Lepor emphasizes that focal therapy should be considered a treatment option for properly selected men with focal disease and presented through shared decision-making as part of contemporary prostate cancer care.
About the 45th Annual Ralph E. Hopkins Urology Seminar
The Annual Ralph E. Hopkins Urology Seminar, also known as the Jackson Hole Seminars, brings together distinguished urologists, clinical researchers, and thought leaders to share wisdom and experience that drives meaningful progress in patient care. Changes occur in medicine and urology on an almost daily basis, so it is imperative that the practicing urologist remains on the cutting edge. Urologists need to keep current on assessing, diagnosing, and treating urologic conditions in the clinical setting. The 45th meeting took place in 2026, focusing on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. 2026 also marked the meeting’s first-ever all-female speaker panel.
ABOUT THE AUTHOR
Herbert Lepor, MD, received his undergraduate degree from the University of California, Los Angeles, Los Angeles, California, in 1975 and his doctor of medicine from The Johns Hopkins University School of Medicine, Baltimore, Maryland, in 1979. Dr. Lepor completed his surgical and urology residency training at NYU School of Medicine in New York, New York.
In 1993, Dr. Lepor was appointed Professor and Chairman of the Department of Urology, NYU School of Medicine and Professor of Pharmacology at NYU School of Medicine. Dr. Lepor is presently Urologist in Chief at NYU Langone Medical Center, and the “Martin Spatz Chairman of the Department of Urology." Dr. Lepor’s primary clinical and basic research interests are related to the prostate.
Dr. Lepor has served on the editorial boards for four major urological journals and has authored over 350 peer reviewed articles, 50 book chapters, and 12 books related to prostate cancer, benign prostatic hyperplasia (BPH), and the pharmacology of the prostate. He is the co-founder and editor of Reviews in Urology. Dr. Lepor has been a visiting professor at 30 institutions. Some of Dr. Lepor’s landmark scientific contributions have focused on the identification of the autonomic intervention regulating male sexual function, development of the nerve sparing radical prostatectomy, improving outcomes following radical retropubic prostatectomy, characterization of the prostate alpha1 adrenoceptor, and the medical and surgical management of BPH.
In 1995, Dr. Lepor was awarded the Gold Cystoscope Award by the American Urological Association. Dr. Lepor is a member of the American Association of Genitourinary Surgeons, Clinical Society of the American Association of Genitourinary Surgeons, the American Surgical Association, and the Johns Hopkins University Society of Scholars.
