What are the pros and cons of focal therapy for prostate cancer?

Focal therapy is an alternative to surgery or radiation for prostate cancer. It is attractive to many patients because it is a middle ground between radical (whole gland) treatment and Active Surveillance. Like all treatments, focal therapy has pros and cons.

Focal therapy pros

• Minimal-to-noninvasive
• Targets just the cancer with immediately lethal ablation (destruction)
• Spares healthy tissue to greatly reduce side effect risks
• Able to monitor and confirm treatment effect
• Outpatient
• Quick return to normal activity
• Early data suggests comparable cancer control to whole gland treatment

Focal therapy cons

• Not everyone is a candidate for focal therapy
• Candidates must be thoroughly qualified
• Risk of recurrence
• No long-term data exists yet, only short- and medium-term studies.

Can published statistics help with making a treatment choice?

No prostate cancer treatment has a 100% guarantee. For each method, the more long-term data and the larger the pool of patients, the more reliable the estimate of estimate of success. Let’s say you are considering a focal treatment. Your doctor says there’s no long-term data, but based on 5 years of data, Method A has a 15% chance of treatment failure (recurrence) vs. 20% for Treatment B

 “Hmmm,” you might think, “I like the idea of Method B but there’s a 20% chance that my cancer will come back, and an 80% chance that it won’t. I know there’s no guarantee, but 8 chances out of 10 that cancer won’t come back is pretty good odds. Since I like Method B better, that’s the one I want.”

Predicting the outcome based on published statistics can help decide which treatment you prefer. But what if biological evidence from your own body could predict treatment success or failure?

Can focal therapy outcomes be predicted based on genomic biomarkers?

A new (Sep. 2025) study by Weiner, et al.^[i] suggests a biological way to predict which focal therapy patients will or won’t have recurrence after treatment. It is based on genomic biomarkers.

A brief word about genomic biomarkers, which constitute biological evidence of how dangerous an individual’s prostate cancer is. According to the national patient information site Zero Prostate Cancer, “Biomarker testing in prostate cancer looks at how certain sets of genes in the tumor interact and function. … The activity of these genes can influence the behavior of the tumor, including how likely it is to grow and spread.”

Biomarkers can be obtained from blood, urine or tissue. For the 2025 study, they were obtained from biopsy tissues so the genes in prostate cancer cells could be analyzed. The analysis used the Decipher test, which gives a genomic classifier score (GC score). The score ranges from low danger (less than .45 GC score) to high (equal to or greater than GC score .45).

The study had 108 patients. All had Grade Group 2-4 prostate cancer on one side of the gland. Their biopsy samples were used to obtain GC scores (71 patients had low scores, 37 had high scores).

Each patient had a focal (partial gland) cryo ablation (freezing) on the cancerous side of the gland. At 6 months after treatment, multiparametric MRI was used to guide targeted biopsy to any suspicious area seen in the treated side of the gland (in-field recurrence).

What did the results show?

Results showed a 21% rate of in-field recurrence for those with low GC scores vs. a 46% rate of in-field recurrence for those with high GC scores. A Urology Times news story says, “When GC score was treated as a continuous variable, higher scores remained associated with increased odds of treatment failure.”

Is this analysis available if I’m considering focal therapy?

Unfortunately, use of the GC score to predict focal therapy outcome is not yet available. The results reported here were gained from a clinical trial. One study is not enough, however. More research is needed to confirm this use of GC score to guide focal therapy decisions.

The good news is that this study poses a new possibility for decision-making. Obtaining a GC score from a patient’s biopsy samples before focal therapy is feasible, and may add a helpful element in doctor-patient discussion before treatment. More data and FDA approval will be needed to use the Decipher system to help focal therapy decision-making. Stay tuned, we’ll keep you posted as similar studies are published.

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.

References

[i] Weiner AB, Proudfoot JA, Aker M, Cardenas M et al. Genomic Biomarker for Prostate Cancer Focal Therapy: Post Hoc Assessment of a Phase II Clinical Trial. JCO Precis Oncol. 2025 Sep;9:e2500535.