One study from 2019 found that 24.2% of respondents use FT in their practice.1 Our goal in this study was twofold: evaluate the current state of FT in the US and compare our results to the previous study to ascertain the change over time.2 We emailed a 22-item questionnaire to members of the American Urological Association (AUA) and received two hundred and sixty-four responses. Responses to four main questions from the survey are represented in Figure 1.
Figure 1: Responses to four survey questions
Our survey found that 43.6% of responding urologists use FT in their practice. Fellowship training in urologic oncology (p=0.001, p=0.0006) and seeing more than 10 new CaP patients per month (p=0.002, p=0.0004) were significant predictors of using FT. There was a significant increase in the utilization of FT (p=<0.0001), belief in index lesion theory (p=0.0004), and belief in how beneficial FT is for the treatment of CaP (p=0.0001) from our study compared to the study from 2019.
The results of our study indicate that FT is growing in popularity in the US. There are many possible causes for this increase. Better imaging methods were selected by 85.4% of respondents as a factor that has increased the utilization of FT. Another factor that could also be contributing is an increase in the use of shared decision-making models. Utilizing shared decision-making leads to a decrease in surgical intervention rates.3 When comparing the side effect profiles of various treatments for CaP, patients are likely to prefer FT over radical surgical treatment.
FT is likely to continue to grow. Of the respondents that do not currently use FT, 38.4% are likely or very likely to consider using FT in the future. Additionally, lack of experience (51.8%) and lack of infrastructure (43.1%) were two of the top three selected reasons for not using FT. Both of these reasons are contextual and likely to change as FT expands.
As with most surveys, respondent bias may have influenced these results, as those interested in FT may be more likely to answer a survey. Additionally, two hundred and sixty-four urologists are a small subset of urologists in the US. Therefore, the survey results may not accurately reflect the overall attitudes and practices of urologists in the US. A more systematic approach to obtaining data regarding the use of FT is necessary to validate these results. Some possibilities include using Medicare and other insurance claims data or analyzing data from manufacturers of FT equipment.
Written by:
- Jason Koehler, BS, University of Cincinnati College of Medicine, Cincinnati, OH
- Abhinav Sidana, MD, MPH, Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
- Jain AL, Sidana A, Maruf M, Sugano D, Calio B, Wood BJ, et al. Analyzing the current practice patterns and views among urologists regarding focal therapy for prostate cancer. Urol Oncol. 2019 Mar;37(3):182.e1-182.e8.
- Koehler J, Lazarovich A, Tayebi S, Viswanath V, George A, Hsu WW, et al. Shifting tides: A survey analysis of urologists’ evolving attitudes toward focal therapy for prostate cancer. Indian Journal of Urology. 2025 Mar;41(1):59.
- Niburski K, Guadagno E, Mohtashami S, Poenaru D. Shared decision making in surgery: A scoping review of the literature. Health Expect. 2020 Oct;23(5):1241–9.