How to cite: Javier-DesLoges J. “Pro: Focal Therapy for Prostate Cancer.” November 13, 2025. Accessed Oct 2026. https://grandroundsinurology.com/pro-focal-therapy-for-prostate-cancer/
Summary
Juan Javier-DesLoges, MD, MS, Assistant Professor of Urology, University of California, San Diego, San Diego, California, argues in favor of focal therapy as a prostate cancer treatment option intended to reduce treatment morbidity while maintaining cancer control in carefully selected patients. He uses a case example of a man treated with radical prostatectomy who achieved early continence but developed persistent erectile dysfunction despite final pathology showing organ-confined disease and very low tumor volume. Dr. Javier-DesLoges uses this outcome to highlight the potential disconnect between whole gland treatment and the true volume and location of clinically meaningful disease in some patients. He emphasizes that erectile function recovery after radical prostatectomy is not uncommon, and considers focal therapy as an option that has lower rates of incontinence and erectile dysfunction.
Dr. Javier-DesLoges emphasizes patient preference, safety goals, and improved disease localization with magnetic resonance imaging (MRI) and prostate-specific membrane antigen positron emission tomography (PSMA PET) when discussing focal therapy. He reviews evidence supporting focal high-intensity focused ultrasound (HIFU) as an option and describes candidate selection. He also considers other focal therapy modalities, including cryoablation, HIFU, transurethral ultrasound ablation (TULSA), and irreversible electroporation, emphasizing that lesion location and patient factors influence which modality is feasible. He stresses the need for structured post-treatment surveillance, including prostate-specific antigen monitoring, confirmatory biopsy, and imaging.
About the 32nd Annual Perspectives in Urology: Point Counterpoint conference: Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, this conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking.
ABOUT THE AUTHOR
Juan Javier-DesLoges, MD, MS, FACS, is an Assistant Professor of Urology and a Urologic Oncologist at the University of California, San Diego. Dr. Javier-DesLoges specializes in robot-assisted minimally invasive surgery as well as transperineal procedures, including SpaceOAR Hydrogel (a rectal spacer), prostate biopsy, and cryoablation. His clinical focus is on the management of prostate, bladder, kidney, and ureteral cancer.
