“People have been looking into focal therapy for a long time now. If you look at the old studies and radical prostatectomy specimens, 85% of prostate cancers are multifocal. That’s why treatment is always the treatment of the total gland, not just the focal area. It even happens with a multiparametric MRI. The MRI may miss a spot. A biopsy can test positive even though nothing was seen on the MRI. So, you run the danger of under-treating patients with focal therapy. That’s been my training and my experience in practice.
Studies comparing conventional biopsies detected high incidence of high-grade cancer, but actually detected fewer cancers than the biopsies. We don’t have the technology to visualize all the cancers yet, otherwise that should not have happened. The multiparametric MRIs should have had a higher incidence of detection of cancer. There seems to be a potential for higher recurrence by using focal therapies. So the jury is still out.
I don’t think replacing active surveillance with focal therapy is a real option. When patients choose focal therapy, I think their expectation is to be cured.”
Young Kang, MD
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