Would you consider focal therapy for a patient with NCCN unfavorable intermediate risk prostate cancer, but only 1/16 cores positive, and it's from a targeted lesion biopsy?

A targeted biopsy confirms the MRI lesion is cancer so treatment should be based on imaging and not core #, core length, etc. We routinely treat MRI visible and MRI invisible GG3 with both HIFU and Cryo, depending on the location.

Yes, definitely can consider ablation for an unfavorable intermediate risk cancer.

Is it an unfavorable intermediate risk based on the Grade group or PSA? Sometimes PSA density is more accurate than overall PSA.

In addition, there are several factors to consider, including the mm length of pattern 4, the size of the lesion, the lesion location, etc.

If there is a small lesion and a shorter length of pattern 4 (I prefer it to be less than 4 mm if possible, though no clear data on this yet), ablation is a very reasonable option.

You can also get PSMA PET/CT imaging based on NCCN guidelines for unfavorable intermediate risk disease, which can confirm the localization of the cancer and the absence of metastases before considering a local therap...