The Merriam-Webster Dictionary defines a gray area as “an area or situation in which it is difficult to judge what is right and what is wrong.” Some philosophically-minded folks may simply shrug off a gray area, figuring that what isn’t clear today might well become clear tomorrow—so life goes on.

However, there are times when living with a gray area is hard. This is the case for many men newly diagnosed with low-risk localized prostate cancer (PCa). Today’s patients access tons of information on their smartphones and computers, often starting with nationally-recognized centers like the Mayo Clinic, Johns Hopkins, Cleveland Clinic, etc. Or, they may turn to societies like the Prostate Cancer Foundation or American Cancer Society. Some patients will surf youtube videos (not always the best information source, according to studies) or plunge into the patient world through online forums to explore what other patients have done.

With all that they learn, it often boils down to a black-or-white dilemma. On the one hand, there are whole gland treatments like radical prostatectomy or radiation that have high rates of long term cancer control as monitored by annual PSA tests, but they come with risks of side effects that may be short-to-long term. On the other hand, with thorough diagnosis and evaluation (age, PSA, multiparametric MRI, needle biopsy, other factors like family history/genomics) they are candidates for Active Surveillance with monitoring protocol as prescribed.

This is where some low-risk patients feel lost in a gray area. They have found new information that low-grade PCa (e.g., Gleason grade 3+3 or Grade Group 1) may never become life threatening. Never? As one Johns Hopkins source, urologists Nirmish Singla, M.S. states, “Grade group (GG) 1 prostate cancer is considered low-risk based on its non-aggressive clinical course for the majority of patients… However, there is an uncommon subset of these low-grade tumors that is capable of invading through the capsule of the prostate.”

For the majority of low-risk patients, then, it’s possible that a whole-gland treatment is over treatment. It can bring them peace of mind but at a price if they end up with with immediate or late onset urinary, sexual or bowel problems. And yet, going on Active Surveillance makes many men anxious or fearful, haunted by the thought that a time bomb is ticking in their body. This is what I call the gray area blues.

Focal therapy: a cure for the gray area blues

Having previously mentioned well-respected cancer centers, I want to focus on one in particular, UCLA Health’s Jonsson Comprehensive Cancer Center (JCCC). In 1976, the National Cancer Institute recognized this center’s “sustained excellence in cancer research, education, and outreach into Los Angeles County communities and well beyond” by designating it as a Comprehensive Cancer Center. JCCC thus carries authoritative weight, and in May 2025 they posted an article on focal therapy as well as multiparametric MRI, both of them ways to help patients safely hold off on overtreatment while avoiding unnecessary monitoring biopsies. (The article is a report on a UCLA study published in theJournal of Urology.)

In part, the article states:

The team found that routine follow-up biopsy, previously considered essential, can now be replaced in most instances by MRI. Further, among men whose cancer was slightly more aggressive, those who had focal therapy were much more likely to avoid surgery or radiation than others who did not have the therapy. The researchers found 84% of men who received focal therapy avoided surgery or radiation, compared to just 46% of those who did not receive the treatment.

At our Center, we specialize in Focal Laser Ablation (FLA), a precise outpatient procedure performed under real-time MRI guidance. For qualified patients, it targets and destroys the PCa lesion while sparing healthy prostate tissue. Thus, our patients have high rates of normal urinary and sexual function after treatment, and quickly return to normal activity. No surgery, no radiation.

In addition, we also offer TULSA, a focal treatment with an “inside out” approach since it is delivered through the urethra. To find out if you qualify for a focal therapy, or to learn more about how a focal approach can help avoid surgery or radiation, contact us.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.