A NCDB analysis reports 1.3% of men with localized prostate cancer treated at Commission on Cancer–accredited US centers from 2010–2023 (n=15,672) received focal therapy. Notably, over half of those patients had disease for which focal therapy is not guideline-supported, including low-risk where active surveillance is preferred as well as high-, or very high-risk where focal treatment is presumably missing the mark. And, again, this is strictly at CoC-accredited centers. Notably, focal treatment is definitionally shifting: cryotherapy fell from 80% to 19% of focal treatments, supplanted by laser ablation (increasing from 15% to 46%) and other tumor destruction methods such as high-intensity focused ultrasound (increasing from 6% to 35%). “These findings underscore the importance of distinguishing selective investigational use from routine adoption of focal therapy ahead of appropriate evidence.” | Cosenza, JAMA 2026
