What do you tell patients that opt for High-intensity focused ultrasound (HIFU) for favorable intermediate risk prostate cancer over AS (Active Surveillance), RP (Radical Prostatectomy), EBRT (External Beam Radiation Therapy), or brachy?

There are currently no published trials that specifically address this question, which is a very good one.

My general discussion is that ablation therapies (not specifically HIFU) will have less negative impact on quality of life factors such as preserving erectile function, avoiding urinary incontin...

Urology and radoncs differ in their approach to this. Recent (inflammatory) social media discussions have shown this.

There are limited prospective data on focal therapies versus whole-gland approaches, but the retrospective data should give us all pause.

What we do know:

• HIFU has significant toxic...

The data on focal therapy is becoming more mature, helping guide conversations with patients. It is consistently shown that the risk of progression after focal therapy rises as grade increases. In one series:

• Grade group 2 (n≈870): failure-free survival 86.5% at 24 months, 60.5% at 60 months
• Grade g...

HIFU still requires surveillance biopsy periodically. Salvage therapy after HIFU also has high toxicity. AS or radical prostatectomy has the lowest toxicity among these options.

I tell patients that most often prostate cancer is multifocal and sometimes multicentric, with most of the danger coming from the index lesion Wheeler T,"...unifocal tumors were found in 22% of all cases versus 78% identified with multifocal disease, with a mean of 2.24 cancer foci. The mean index t...