Focal Therapy in Grade Group 3 Prostate Cancer

Sep 21, 2026

A review assesses how to treat low-volume, localized unfavorable intermediate-risk prostate cancer (Grade Group 3, GG3) while preserving quality of life. Focal therapy is reviewed as a focused alternative to whole-gland radical treatment, which can cause significant side effects. Literature summarizes safety and efficacy evidence, highlighting that some patients with higher-volume bilateral disease may require radical therapy. Reported failure-free and overall survival outcomes remain high despite local recurrence considerations with close follow-up and selective salvage.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Abstract

Introduction

Patient selection for focal therapy

Cryotherapy

Reported outcomes and limitations

Current Urology Reports (2024) 25:271–275 [https://doi.org/10.1007/s1](https://doi.org/10.1007/s1) 1934-024-01211-x Focal Therapy in Grade Group 3 Prostate Cancer Lee Pressler1 · Mariel Pressler2 Accepted: 14 May 2024 / Published online: 2 July 2024 © The Author(s) 2024 Abstract Purpose of this Review Treatment of intermediate risk prostate cancer remains controversial. Clearly some patients with low volume favorable intermediate risk can be followed with active surveillance. Those with high volume bilateral disease need more radical whole gland therapy. The question remains on how to best treat low volume localized unfavorable intermediate risk prostate cancer (GG3) while maintaining quality of life. Focal therapy has been becoming a popular option for many patients with localized prostate cancer. Most studies looking at focal therapy for prostate cancer have been limited to GG1 and GG2, many of whom may not need treatment. We set out to review the literature evaluating the safety and efficacy of focal therapy for GG3 prostate cancer. Recent Findings We reviewed multiple peer review articles obtained from a PubMed search. While in field biopsy recurrence rates approach 20%, failure free survival and overall survival exceeds 90% . Summary While focal therapy for unfavorable GG3 intermediate risk prostate cancer may have higher rates of local recurrence with appropriate post procedure follow up, patients who need salvage therapy are easily identified and survival rates are very high. Focal therapy is a good option for patients with localized low volume GG3 prostate cancer without compromising cancer survival and preserving quality of life. Keywords Focal Therapy · Prostate cancer · Intermediate risk · HIFU · Cryotherapy · IRE Introduction Prostate cancer is the leading cause of cancer in men over 50 years old. With the wide use of screening since the late 1980’s there has been a large increase in the number of men diagnosed with early prostate cancer. The shifting of time of diagnosis to as many as 10 years earlier has resulted in a significant decrease in prostate cancer related deaths over the past 30 years. However, this has come at the cost of over treating many men with low risk cancer resulting in often life changing side effects such as erectile dysfunction, stress urinary incontinence and radiation related injury. With the increased use of active surveillance for low risk grade group 1 (GG1) and some grade group 2 cancers (GG2) the pendulum has swung back to a more appropriate place whereby we tend to observe low risk patients and * Lee Pressler [lpressler@gsunj.com](lpressler@gsunj.com) 1 Clinical Instructor Rutgers New Jersey Medical School, Morristown Medical Center, Morristown, NJ, USA 2 New York Columbia Presbyterian Medical Center, New York, NY, USA treat high risk patients. The controversy remains on how to treat patients with intermediate risk prostate cancer, specifically those with unfavorable intermediate risk prostate cancer with grade group 3 Gleason 7 (4 + 3) disease. Do these patients need whole gland radical therapy with its associated quality of life issues or is there a subset of patients who could be safely treated with a less invasive modality coupled with close monitoring? While radical prostatectomy or radiotherapy remain the standard of care for localized intermediate risk prostate cancer, concerns about overtreatment and side effects have driven the exploration of minimally invasive alternatives. Focal therapy (FT) targets only the cancerous foci within the prostate, aiming to preserve healthy tissue and potentially minimize morbidity. The wide use of mpMRI has enabled clinicians to better map the location of prostate cancer within the prostate and often identify an index lesion that may be the driver of the cancer’s clinical activity. Radtke et al. looked at radical prostatectomy specimens and found that 96% of the index lesions were correctly identified with th

FAQs

What survival performance does the review summarize for focal therapy in GG3?

The review reports that failure-free survival and overall survival exceed 90% in the recent findings section. It also notes that local recurrence rates may be higher in unfavorable GG3, but salvage therapy can identify appropriate patients and survival remains very high with follow-up.

Sep 21, 2026

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