The Expert APProach: Focal Therapy and Precision Prostate Cancer Care, With Anup A. Vora, MD

Welcome back to The Expert APProach!

In this episode of The Expert APProach: Conversations in Uro-Oncology, host Joy Maulik, CRNP, is joined by Anup A. Vora, MD, clinical director of prostate cancer focal and ablative therapy at Chesapeake Urology, for an in-depth discussion on the evolving role of focal therapy in localized prostate cancer.

Drawing on his experience in minimally invasive, precision-based prostate cancer care, Vora explores how advances in imaging, genomics, and shared decision-making have expanded treatment options beyond the traditional paradigm of surgery, radiation, or active surveillance. He explains how careful patient selection is essential to identifying candidates who may benefit from focal ablative therapies while preserving urinary and sexual function.

The conversation also examines the realities of surveillance following focal therapy and the importance of setting appropriate patient expectations. Vora discusses how MRI, prostate-specific antigen monitoring, repeat biopsies, and, when appropriate, PSMA-PET imaging contribute to long-term follow-up, emphasizing that focal therapy requires ongoing vigilance rather than a one-time intervention. He also addresses the psychological aspects of prostate cancer management, noting that for some patients, focal treatment can provide a balance between oncologic control and quality of life while alleviating the anxiety associated with active surveillance. Looking ahead, Vora shares his perspective on how artificial intelligence, predictive pathology, and genomic testing may further individualize treatment selection and improve outcomes through increasingly precise approaches to genitourinary oncology.

Beyond advances in technology, Maulik and Vora discuss the expanding role of advanced practice providers (APPs) in delivering comprehensive prostate cancer care. Vora highlights how APPs are increasingly serving as care coordinators and clinical partners, helping guide patients through screening, surveillance, survivorship, and the management of treatment-related effects while ensuring continuity across the cancer care continuum. The discussion also explores opportunities for APPs to take on expanded procedural responsibilities through appropriate training, improving access to care amid the growing shortage of urologists. Together, Maulik and Vora reflect on the future of multidisciplinary GU oncology, where precision medicine, collaborative practice, and patient-centered care will continue to shape how clinicians diagnose, treat, and support patients with prostate cancer and other urologic malignancies.