Clint Bahler, MD, reflects on precision medicine and focal therapy highlights at AUA 2026

The 2026 American Urological Association Annual Meeting highlighted the continued evolution of prostate cancer management toward more personalized, risk-adapted, and function-preserving care. Across plenary presentations, scientific sessions, and expert discussions, investigators explored strategies for treatment intensification and de-escalation, advances in imaging and biomarker-driven decision-making, and the expanding role of focal therapy within the prostate cancer treatment landscape.

In the following Q&A, Clint D. Bahler, MD, of Indiana University Health, reflects on several of the meeting’s most impactful themes and discusses how recent advances may influence clinical practice in the years ahead. Bahler offers his perspective on the integration of imaging, biomarkers, and risk stratification tools into treatment planning, as well as the ongoing conversations surrounding focal therapy and its place among established treatment options for localized prostate cancer.

The discussion also examines the recently launched SONA FUSION Registry (Sonablate Focused Ultrasound Study for Integrated Outcomes Network), a global outcomes initiative designed to generate long-term real-world evidence for high-intensity focused ultrasound (HIFU) in both prostate cancer and benign prostatic hyperplasia.¹ As principal investigator of the registry, Bahler outlines its goals, including the collection of standardized data on oncologic outcomes, functional preservation, retreatment rates, complications, and patient-reported quality-of-life. With plans to enroll more than 5000 patients across multiple countries and clinical settings, the registry aims to address persistent evidence gaps in focal therapy and provide data that may help inform clinical practice and future research.

Urology Times: What were some themes regarding treatment intensification or de-escalation at AUA 2026 that you think will meaningfully influence patient management over the next few years?

Bahler: [The field is focusing on] trying to find alternatives to hormone therapy for men and also trying to select men who don't need whole-gland therapies, which are robotic surgery or radiation. There were a lot of centers presenting their [experiences] with focal therapy, [trying to determine] who makes for a good candidate based on who had good treatment success. Focal therapies are a way that we're de-escalating treatment.

[In terms of] treatment intensification, we're starting to standardize the pelvic lymph node dissection of prostate cancer. There have been guideline updates about including extended node dissection. At the AUA, there was an update on a trial with long-term follow up showing that if [patients have] unfavorable intermediate-risk or high-risk disease, there is clinically significant benefit to extended lymph node dissection. [We also saw data on] new targeted systemic therapies [that are] helping stimulating the immune system or radioligands that deliver radiation in a targeted way for men that are at higher risk.

Urology Times: How do you see the latest data on imaging, biomarkers, or risk stratification tools changing the way urologists approach diagnosis and treatment selection in prostate cancer?

Bahler: We're at an interesting juncture where AI tools are slowly becoming integrated into medicine. For instance, AI is being used in digital pathology to look for patterns that go beyond the naked eye. That helps to risk stratify patients beyond the classical staging/grading system that we have. Decipher is another [tool] that risk stratifies.

[The issue is that this is] still a bit fragmented. We have genomic status that's shown to be an independent risk stratifier, and of course, we have our grade and stage. Now we're having AI, or computational tools, that are also risk stratifying, and we’re also adding in molecular imaging with PSMA-PET. Right now, risk stratification is a bit of a crowded field. [These are] wonderful tools, but we need a way to integrate these into a common decision-making platform.

Urology Times: There continues to be discussions around focal therapy for prostate cancer. Based on sessions at AUA 2026, where do you think focal therapy currently fits within the prostate cancer treatment landscape?

Bahler: Focal therapies are starting to change the field and change the way patients look at treatment. If they have to do a whole-gland treatment with robotic surgery or radiation, there are significant risks of [adverse] effects. It's a catch-22 in a way; we tell patients, "If you catch the cancer earlier, it's easier to treat.” The treatment can be less aggressive. With radiation and robotic surgery, there's always going to be some risks to urinary continence and erectile function. One of the places that focal therapy is really compelling and makes a lot of intuitive sense is now you have a treatment for those men that are aggressively screening to catch their cancer early, and you have a less aggressive treatment approach. It enables more precision, and the treatment may be more personalized. It's important that those men feel like if they do a focal therapy like high intensity focused ultrasound, they still have a way, if there's a treatment failure, to rescue that in time for a cure.

Urology Times: Just prior to AUA 2026, Sonablate announced the launch of the SONA FUSION Registry. From your perspective, why is a large-scale, real-world evidence initiative important in the focal therapy space?

Bahler: This is an effort to bring HIFU users together to discuss outcomes and share techniques. One of the most important things I see in a registry like this is that it brings together treating practitioners to discuss results. Hopefully this will also do some of the heavy lifting for data collection. The registry is a footprint of de-identified or anonymized data from patients, acting as a database, which then all the participating centers can use for quality monitoring. Hopefully it stimulates publications as well. We want to see private or academic centers in the United States publish their HIFU data so we understand the best candidates for focal therapy and the best techniques in HIFU.

Urology Times: As you mentioned, the SONA FUSION Registry is designed to collect global real-world outcomes. What data will be most valuable for clinicians evaluating focused ultrasound technologies? How might these findings shape the role for these treatment options in clinical practice?

Bahler: Many people choose focal therapy due to the quality-of-life outcomes, but those have been well documented. Focal therapy has good preservation of erections and urine control that I think the oncologic outcomes will initially be what I'm most interested in. [One example] is the treatment failure rate and when those treatment failure rates happen. Hopefully that could drive us to safer follow-up regimens for men that have HIFU, so that those that do fail can get diagnosed and can get on to re-HIFU or definitive therapy with radiation or surgery.

REFERENCE

1. Sonablate Launches SONA FUSION Global Registry to Advance Precision Sound Medicine and Define Future Standards in Focal Therapy. News release. Sonablate. May 14, 2026. Accessed June 5, 2026. https://www.biospace.com/press-releases/sonablate-launches-sona-fusion-global-registry-to-advance-precision-sound-medicine-and-define-future-standards-in-focal-therapy