FOCAL THERAPY for prostate cancer (PCa) is gaining attention as a treatment that may eradicate cancer while preserving urinary, sexual, and bowel function. Unlike whole-gland interventions such as surgery or radiotherapy, focal therapy targets only the diseased portion of the prostate. Several retrospective and prospective studies have shown favourable outcomes, particularly for patients with localised intermediate-risk PCa. However, recurrence rates remain a concern, with up to one third of men experiencing disease return within two years. This has led to renewed focus on refining patient selection.
One promising avenue lies in the use of genomic tools. The Decipher genomic classifier (GC), already validated in men undergoing radical prostatectomy and radiation, evaluates the expression of 22 genes linked to tumour aggressiveness. By integrating this genomic information, clinicians may be able to predict which patients are more likely to benefit from focal therapy, and which may require more radical approaches.
Genomic insights for prostate cancer treatment
In this post hoc analysis of a prospective trial, men with higher GC scores were significantly more likely to experience treatment failure following focal therapy. Specifically, GC-high patients showed recurrence rates of 46% at six months and 76% at 18 months, compared with 21% and 44% for GC-low patients. Even after accounting for conventional risk factors such as PSA density, tumour grade, and MRI findings, the GC score independently predicted treatment outcomes.
This distinction is critical. Treatment failure after focal therapy not only increases the need for additional interventions but may also raise healthcare costs and elevate the risk of disease progression. Incorporating genomic classifiers could therefore improve patient selection, reduce unnecessary retreatments, and support personalised cancer care.
Towards tailored prostate cancer management
Although no universal definition of focal therapy success exists, evidence suggests that genomic classifiers like Decipher could transform clinical decision-making. Patients with GC-low tumours, particularly those of the luminal LD subtype, may be the best candidates for focal therapy or even active surveillance. By contrast, those with GC-high profiles may benefit more from up-front prostatectomy or radiation.
As research evolves, integrating genomics into treatment pathways could help balance cancer control with quality of life, marking an important step towards tailored prostate cancer management.
Reference
Weiner AB et al. Genomic biomarker for prostate cancer focal therapy: post hoc assessment of a Phase II clinical trial. JCO Precis Oncol. 2025;9:e2500535.
