Focal therapy for localized prostate cancer offers organ-sparing oncological control with functional preservation for carefully selected men, but the uptake of this approach remains limited. Prioritizing principle-based evaluation, long-term registries and aligned reimbursement will facilitate the adoption of focal therapy into guideline-endorsed standard of care.
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References
Ahdoot, M. et al. MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N. Engl. J. Med. 382, 917–928 (2020).
Klotz, L. et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J. Clin. Oncol. 33, 272–277 (2015).
Hamdy, F. C. et al. Partial ablation versus radical prostatectomy in intermediate-risk prostate cancer: the PART feasibility RCT. Health Technol. Assess. 22, 1–96 (2018).
Bill-Axelson, A. et al. Radical prostatectomy or watchful waiting in prostate cancer – 29-year follow-up. N. Engl. J. Med. 379, 2319–2329 (2018).
Donovan, J. L. et al. Patient-reported outcomes 12 years after localized prostate cancer treatment. NEJM Evid. 2, EVIDoa2300018 (2023).
Pinsky, P. F. et al. Extended mortality results for prostate cancer screening in the PLCO trial with median follow-up of 15 years. Cancer 123, 592–599 (2017).
Wilt, T. J. et al. Radical prostatectomy or observation for clinically localized prostate cancer: extended follow-up of the Prostate Cancer Intervention Versus Observation Trial (PIVOT). Eur. Urol. 77, 713–724 (2020).
Higgins, B. & Thompson, I. M. The Prostate Cancer Prevention Trial: current status. J. Urol. 171, S15–S18 (2004).
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Balaji, S., Lepor, H. & Polascik, T.J. How urology can embrace the patient-centric precision focal therapy approach for localized prostate cancer. Nat Rev Urol (2026). https://doi.org/10.1038/s41585-026-01136-9
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DOI: https://doi.org/10.1038/s41585-026-01136-9