Parameters Predicting Recurrence after Focal Therapy for Prostate Cancer: Insights from a Multicenter Surveillance...

Focal therapy (FT) represents a minimally invasive option for selected patients with localized prostate cancer (PCa), aiming to achieve oncological control while preserving functional outcomes. Despite its increasing adoption, long-term efficacy data remain limited and predictors of recurrence are not well defined.

We conducted a retrospective multicenter cohort study of 209 men with histologically confirmed unifocal or oligo-focal (≤3 lesions) PCa treated with FT (high-intensity focused ultrasound [HIFU], vascular-targeted photodynamic therapy [VTP], cryotherapy, or transurethral ultrasound ablation [TULSA]) between 2019 and 2024 at three German centers. Clinical, histopathological, treatment-related, and multiparametric magnetic resonance imaging (mpMRI) parameters were prospectively collected in a REDCap-based registry. Recurrence-free survival (RFS) and progression-free survival (PFS) were analyzed using Kaplan-Meier estimates, and Cox regression was applied to identify independent predictors.

Median patient age was 66 years and median prostate-specific antigen was 6.4 ng/mL. ISUP grade distribution was 58% grade 1, 29% grade 2, and 13% grade ≥3. Treatment modalities comprised HIFU (43%), VTP (35%), cryotherapy (12%), and TULSA (10%). After a median follow-up of 1.73 years, 40% of patients developed recurrence and 15% showed histologic progression. RFS varied by treatment modality (HIFU: 2.26 years; VTP: 1.73 years; cryotherapy: 0.75 years; TULSA: not reached; p = 0.001). Median PFS was 4.7 years. Suspicious baseline mpMRI (PI-RADS 4-5) was associated with shorter RFS. Suspicious follow-up mpMRI strongly predicted both recurrence (RFS 1.1 vs. 2.96 years, p < 0.001) and progression (PFS 1.8 vs. 4.7 years, p = 0.004). In multivariate analysis, suspicious follow-up mpMRI was the only independent predictor of recurrence (HR: 2.07, 95% CI: 1.24-3.45, p = 0.005).

In this multicenter registry analysis, recurrence after FT was frequent, affecting 40% of patients within 2 years. mpMRI findings before and especially after treatment emerged as the strongest predictors of oncological failure, underscoring the central role of standardized imaging in patient selection and surveillance. Prospective studies with longer follow-up and centralized radiologic review are needed to refine FT protocols and optimize patient outcomes.