Study Finds 51% of US Prostate Focal Therapy Cases Fell Outside Guidelines
Updated
Updated · Renal and Urology News · Aug 19
Study Finds 51% of US Prostate Focal Therapy Cases Fell Outside Guidelines
3 articles · Updated · Renal and Urology News · Aug 19
Summary
15,672 US men received focal therapy for nonmetastatic prostate cancer from 2010 to 2023, and 51% of those cases involved low-, high-, or very high-risk disease outside guideline-recommended care.
JAMA guidelines limit focal therapy in intermediate-risk disease to clinical trials or prospective registries, while no level 1 evidence supports routine use in low-, high-, or very high-risk patients.
Use patterns shifted over time: focal therapy rose in favorable intermediate-risk disease to 2.9% from 2.1%, fell in unfavorable intermediate-risk disease to 1.9% from 2.5%, and also declined in high- and very high-risk groups.
Cryotherapy's share dropped to 19.1% from 79.8%, while laser ablation climbed to 45.8% and high-intensity focused ultrasound to 35.1%; older men, patients with more comorbidities, non-private insurance, and non-academic centers were more likely to receive treatment.
An accompanying editorial said professional "group think," reimbursement incentives, and market competition may be driving adoption of unproven focal therapy ahead of evidence.