Abstract: PD56-10
Sources of Funding: This research was funded by the Intramural Research Program of the National Institutes of Health (NIH), National Cancer Institute, Center for Cancer Research.

Introduction

Focal therapy (FT) for localized prostate cancer (PCa) has been shown to have encouraging short term oncological outcomes, excellent preservation of functional outcomes and is increasing in popularity in Urologic community. We aim to evaluate the preferences and practice trends among urologists regarding this upcoming treatment strategy.

Methods

A 20 item online questionnaire was designed to collect information on urologists' views and use of focal therapy. The survey was sent to the members of the Endourological Society (ES) and the American Urological Association (AUA). Multivariate logistic regression analysis was done to determine predictors for utilization of FT.

Results

A total of 425 responses were received [AUA: 342, ES: 83]. Mean age of respondents was 53(±11.3) years. Although half of the respondents (50.8%) believed FT to be moderate to extremely beneficial in the treatment of PCa, only 24.2% (103) of the respondents currently utilize FT in their practice. Of the respondents who were fellowship trained in urologic oncology were more likely to consider FT to be moderately to extremely beneficial (p<0.001). Surgeon's experience (practice for more than 15 years) (p = 0.031) was the only independent predictor for utilizing FT in localized PCa. While the most common setting for utilization of FT was in patients with unilateral intermediate risk (72.8%) PCa, a small percentage of respondents also used FT for patients with unilateral high risk PCa and bilateral intermediate risk (21.3% and 10.6% respectively). The most common FT modality was Cryoablation in 58% followed by High Intensity Focused Ultrasound in 44.6%. Most common reasons for not using focal therapy were the lack of belief in 'index lesion theory' (203) (63%) followed by the lack of experience (133) (41.3%). About 57.6% would use FT more often in an office or outpatient setting if they had access to reliable and cost effective options.

Conclusions

Only a quarter of our respondents utilize FT in their practice with surgeon's experience being the only independent predictor for utilizing FT. Majority of respondents though consider FT to be beneficial in prostate cancer management and would use it more often if provided more reliable and cost effective options. Over time, experience and accessibility to reliable methods to perform FT may lead to further utilization of this novel treatment strategy.

Funding

This research was funded by the Intramural Research Program of the National Institutes of Health (NIH), National Cancer Institute, Center for Cancer Research.