How to cite: Gomella PT. “Point Counter Point: Software-Based Fusion for Focal.” October, 2025. Accessed Mar 2026. https://grandroundsinurology.com/point-counter-point-software-based-fusion-for-focal/
Summary
Patrick T. Gomella, MD, MPH, FACS, Assistant Professor of Urology and Surgery, Co-Director Comprehensive Prostate Cancer Focal Therapy Program, Sidney Kimmel Comprehensive Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, presents the counterpoint position in support of software-based fusion for focal therapy. He explains that although direct focal therapy outcome trials comparing cognitive and software fusion are not available, multiple diagnostic and selection advantages support the use of software fusion in focal treatment workflows. He states that focal therapy outcomes rely heavily on correct patient selection and that software fusion enhances selection by enabling precise tracking of both systematic and targeted biopsy cores. This tracking capability supports the identification of clinically significant lesions and informs ablation margins.
He notes that studies reporting equivalence between cognitive and software fusion typically do not stratify lesions by size. He highlights evidence that software fusion achieves superior detection accuracy for smaller lesions, particularly those under approximately 1.3 centimeters. He emphasises that detecting smaller lesions and registering their precise locations enhances planning for margin-based ablation.
Dr. Gomella explains that software fusion retains core location data, allowing clinicians to re-target biopsy-proven sites even when lesions are invisible on magnetic resonance imaging (MRI). He cites evidence from active surveillance cohorts demonstrating high re-targeting accuracy over extended intervals. He then discusses the advantages of the learning curve, stating that software fusion achieves higher detection performance and reaches proficiency more quickly than cognitive fusion.
Dr. Gomella argues that software fusion aligns with the direction of evolving focal therapy platforms, including tools that incorporate artificial intelligence and advanced imaging synchronisation. He argues that software fusion enables confident targeting of small lesions, supports new practitioners, and facilitates individualized ablation planning.
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
Patrick T. Gomella, MD, MPH, FACS, EMT-P, is an Assistant Professor of Urology at Thomas Jefferson University in Abington, Pennsylvania, where he also serves as co-director of the university’s Comprehensive Prostate Cancer Focal Therapy Program. Dr. Gomella specializes in urologic oncology and the treatment of bladder, kidney, penile, prostate, and testicular cancer. Dr. Gomella is certified by the National Registry of Emergency Medical Technicians.
