Derek Lomas, MD, presented “Patient Selection: How to Pick a Focal Therapy Candidate” during the 2024 Frontiers in Oncologic Prostate Care and Ablative Local Therapy symposium on October 17, 2024, in San Diego, California.
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How to cite: Lomas, Derek. “Patient Selection: How to Pick a Focal Therapy Candidate.” October, 2024. Accessed Oct 2026. https://grandroundsinurology.com/patient-selection-how-to-pick-a-focal-therapy-candidate/
Patient Selection: How to Pick a Focal Therapy Candidate – Summary
Derek Lomas, MD, outlines a comprehensive approach to patient selection for focal therapy in prostate cancer in this 12-minute presentation. The overarching criteria emphasize that focal therapy is suitable for patients with localized, clinically significant disease, distinct from candidates for active surveillance or those unsuitable for surgery or radiation. Two key dimensions, patient and disease characteristics, guide decision-making, balancing individualized patient factors with disease-specific metrics like tumor location and grade.
Patient health status is central, with functional baseline metrics, particularly urinary and sexual function, critical for setting realistic expectations. Patients must be well-informed about focal therapy’s pros, cons, and guideline limitations.
Disease characteristics identify the ideal focal candidate as patients with low- and intermediate-risk cancer. Multiparametric MRI and systematic and targeted biopsies, sometimes repeated, ensure comprehensive mapping.
Dr. Lomas emphasizes the importance of tailoring treatment to available modalities, such as HIFU for posterior lesions or cryoablation for anterior challenges. Critical to the most successful strategy is patient understanding and a willingness to decline unsuitable candidates, reinforcing a commitment to patient-centered care and optimal outcomes.
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
Derek J. Lomas, MD, is an Assistant Professor of Urology at Mayo Clinic in Rochester, Minnesota. Dr. Lomas’ clinical interests include prostate cancer diagnostics and imaging, focal therapies for the treatment of prostate cancer, and minimally invasive treatment of benign prostatic hyperplasia (BPH). His research interests include prostate cancer diagnostics and risk stratification, trans-perineal prostate biopsy, including targeted biopsy, prostate imaging (MRI, Ultrasound), minimally invasive treatments for BPH, and focal therapy for prostate cancer, including high-intensity focused ultrasound and irreversible electroporation.
