A Preoperative Risk Stratification Approach Using the Focal Risk Group (FRG) in Patients Undergoing Focal Therapy for...

Focal therapy is increasingly used for localized prostate cancer, but preoperative risk stratification remains poorly defined. We developed a Focal Risk Group (FRG), a simple clinically informed classification based on commonly available variables, to describe baseline risk of biochemical failure after focal therapy.

We analyzed 324 consecutive patients treated with cryoablation or high-intensity focused ultrasound at a high-volume center.

The FRG included PSA density, ISUP grade group, dominant lesion size, and clinical stage. Patients were classified as low (0-1), intermediate (2), or high risk (3-4). The primary endpoint was biochemical failure-free survival (BFS). Cox regression and Kaplan-Meier analyses were performed; discrimination was assessed using the area under the curve (AUC).

Dominant lesion size was associated with BFS at multivariable analysis (HR 1.03, 95% CI, 1.00-1.06; P = .02). The FRG stratified patients into groups with distinct outcomes (log-rank P = .0013), with 24-month BFS rates of 84.8%, 71.8%, and 59.9% in low-, intermediate-, and high-risk groups, respectively. Discrimination was modest (AUC 0.66).

The FRG was associated with Phoenix-defined biochemical failure after focal therapy and may help describe baseline risk before treatment. Its modest discrimination and exploratory design require cautious interpretation and external validation.