8/13/2026
University of Pittsburgh researchers analyzed data on more than 1 million men to see how focal therapy for prostate cancer is used nationwide.
PITTSBURGH — A University of Pittsburgh-led study published Aug. 13, 2026, in JAMA found that about half of men who received focal therapy for prostate cancer fell outside the patient groups current guidelines recommend for the treatment.
Key Takeaways
- A national study led by University of Pittsburgh School of Medicine researchers, published Aug. 13, 2026, in JAMA, analyzed 1,179,384 men age 50 and older diagnosed with nonmetastatic prostate cancer between 2010 and 2023 using the National Cancer Database.
- Among 15,672 patients who received focal therapy, about half belonged to low-risk, high-risk or very-high-risk groups for whom current clinical guidelines do not recommend the treatment.
- Low-risk patients may receive unnecessary focal therapy when active surveillance could be an option, while high-risk and very-high-risk patients may need more aggressive treatment than focal therapy currently provides.
- Senior author Quoc-Dien Trinh, M.D., M.B.A., chair of the Department of Urology at the University of Pittsburgh School of Medicine, said the findings highlight the need to match treatment to patients most likely to benefit.
- The National Cancer Database does not capture clinical trial participation, long-term outcomes, side effects or retreatment rates, and focal therapy performed outside Commission on Cancer-accredited centers may not be included in the analysis.
Prostate cancer is the most diagnosed cancer among men, affecting about one in eight during their lifetime, according to the U.S. Centers for Disease Control and Prevention. For some men with intermediate-risk prostate cancer, focal therapy has become an alternative to treating or removing the entire prostate.
Focal therapy is a prostate cancer treatment that targets only the cancerous part of the gland instead of the whole organ. The goal is to preserve healthy tissue and lower the risk of side effects such as urinary incontinence and sexual dysfunction, which can follow surgery or radiation.
What did the study of 1.17 million men reveal about gaps between focal therapy use and prostate cancer guidelines?
To see how focal therapy is being used in practice, researchers analyzed National Cancer Database records on 1,179,384 men age 50 and older diagnosed with nonmetastatic prostate cancer between 2010 and 2023.
Among the 15,672 patients who received focal therapy, about half belonged to low-risk, high-risk or very-high-risk groups — patients for whom the treatment was not recommended by contemporary guidelines and for whom it may not always be the best option.
Why do guideline mismatches matter for low-risk and high-risk prostate cancer patients?
For men with low-risk prostate cancer, focal therapy may be more treatment than necessary, since many can be safely monitored through active surveillance instead. Men with high-risk or very-high-risk disease may need more aggressive treatments with stronger evidence for long-term cancer control than focal therapy can currently provide.
"For appropriately selected patients with intermediate-risk disease, focal therapy is an appealing treatment option because it aims to preserve quality of life while treating the cancer," said senior author Quoc-Dien Trinh, M.D., M.B.A., professor and chair of the Department of Urology at the University of Pittsburgh School of Medicine. "But as promising new technologies become more widely available, it is important to understand which patients are most likely to benefit so that treatment decisions are guided by evidence and aligned with clinical guidelines."
Researchers say findings point to broader need for evidence-based treatment selection
The researchers said the study does not argue against focal therapy. Instead, it points to a broader challenge in cancer care: making sure promising new treatments reach the patients most likely to benefit from them.
Questions remain about long-term cancer outcomes, retreatment rates, treatment-related side effects and quality of life for men who receive focal therapy, the researchers said.
"Innovation is critical in prostate cancer care," said Trinh. "Our findings highlight the need to ensure that promising new treatments are adopted in ways that are supported by evidence and matched to the patients most likely to benefit."
Database limitations point to need for further focal therapy research
The National Cancer Database provides a broad national picture of treatment patterns, but it does not capture participation in clinical trials or prospective registries. It also does not include information on long-term cancer outcomes, quality of life, side effects, retreatment or cost.
Focal therapy performed outside Commission on Cancer-accredited centers may not have been captured in the analysis, meaning the actual number of men who received the treatment could be larger than the study found.
Future studies examining these outcomes could help refine patient selection and inform how clinical guidelines evolve, the researchers said.
"Our main goal is to ensure that each patient receives the treatment that best matches the characteristics of their cancer and their individual needs," added Trinh.
Frequently Asked Questions
Q: What is focal therapy for prostate cancer?
A: Focal therapy is a treatment that targets only the cancerous part of the prostate rather than the whole gland, aiming to preserve healthy tissue and reduce side effects such as urinary incontinence and sexual dysfunction.
Q: Who is focal therapy meant for, according to current guidelines?
A: Current clinical guidelines support focal therapy mainly for men with intermediate-risk prostate cancer. Men with low-risk disease are often better suited for active surveillance, while those with high-risk or very-high-risk disease may need more aggressive treatment.
Q: What did the University of Pittsburgh study find?
A: Researchers found that about half of the 15,672 men who received focal therapy between 2010 and 2023 had low-risk, high-risk or very-high-risk prostate cancer — groups for whom current guidelines do not recommend the treatment.
Additional Resources
- Published study: Focal Therapy for Prostate Cancer | JAMA
- EurekAlert! release: Half of prostate cancer focal therapy use falls outside current guideline-supported groups | EurekAlert!
- What is prostate cancer?: Prostate Cancer | Cancer Care | UPMC Hillman Cancer Center
- Headshot: Quoc-Dien Trinh, M.D., M.B.A.
- Press contact: Allison Hydzik | UPMC Media Relations;
Authors and Funding
Authors: Andrea Cosenza, M.D., David-Dan Nguyen, M.D.C.M., M.P.H., Ph.D.(c), Benjamin J. Davies, M.D., Bruce L. Jacobs, M.D., M.P.H., and Adam Olson, M.D., all of UPMC or the University of Pittsburgh School of Medicine; Giorgio Gandaglia, M.D., and Andrea Cosenza, M.D., both of IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University; David-Dan Nguyen, M.D.C.M., M.P.H., Ph.D.(c), of the University of Toronto, Zhiyu Qian, M.D., and Alexander P. Cole, M.D., both of Harvard Medical School; and Rui Bernardino, M.D., of Cleveland Clinic.
Funding and Disclosures: No funding for this work was provided.
Quoc-Dien Trinh reports consulting fees from Astellas, Bayer, Intuitive Surgical, Janssen, Novartis and Pfizer, research funding from the American Cancer Society and Pfizer Global Medical Grants (Prostate Cancer Disparities #63354905), and funding from the Health Disparity Research Award from the Department of Defense Congressionally Directed Medical Research Program (#PC220551).
Alexander P. Cole reports research funding from the Bruce A Beal and Robert L Beal Surgical Fellowship of the BWH Department of Surgery, the Prostate Cancer Foundation, the American Cancer Society (#23YOUN25) and a Physician Research Award from the Department of Defense Congressionally Directed Medical Research Program (#PC220342).
