Shifting Tides: A Survey Analysis of Urologists' Evolving Attitudes and Practice Patterns in Focal Therapy for Prostate Cancer

Abstract Purpose: Focal therapy (FT) is emerging as an alternative option to radical treatments for prostate cancer (CaP). The purpose of this study is to assess urologists’ current perceptions and utilization of FT. Methods: A 22-item questionnaire was emailed to members of the American Urological Association. Multivariate logistic regression analysis was used to identify predictors of FT utilization. Results were also compared to a previous survey performed in 2017. Results: A total of 264 responses were recorded. Less than half (115/264, 43.6%) of respondents utilize FT in their practice; among them, 42% perform FT on more than 10 patients/year. Common reasons for avoiding FT were diverse and included: lack of experience (51.8%), belief that CaP is multifocal (46.0%), and a lack of infrastructure (43.1%). The most commonly utilized modality for FT was high-intensity focused ultrasound (63.4%) followed by cryoablation (47.3%). Preferred patients selected for FT were primarily unilateral/anterior only Gleason Grade Group 2 (95/110, 86.4%). A fellowship training in urologic oncology (OR=2.86, p=0.008) and seeing more than 10 CaP patients per month (OR=2.46, p=0.002) were associated with greater utilization of FT. Most respondents (85.4%) cited better imaging methods as a factor that has increased FT utilization. Compared to a previous survey, a higher number of respondents (43% vs. 24%) utilize FT in their practice and more respondents believe in the "index lesion theory". Conclusions: Less than half of the respondents utilize FT in their practice. Fellowship training in urologic oncology and a higher volume of CaP patients were correlated with FT utilization. As urologists gain more experience the trend of further utilization of FT for CaP may rise.