A groundbreaking study from UCLA Health Jonsson Comprehensive Cancer Center has demonstrated that integrating advanced MRI imaging with targeted focal therapy can significantly improve the management of prostate cancer, allowing men with low to intermediate-risk disease to safely remain on active surveillance for extended periods while avoiding or delaying more invasive treatments.
Published in The Journal of Urology, the extensive research analyzed data from 869 men enrolled in UCLA's active surveillance program between 2010 and 2022. Each participant underwent an MRI-guided biopsy at baseline that confirmed low to intermediate-risk prostate cancer and remained under surveillance for at least one year.
Transforming Prostate Cancer Monitoring
Traditional prostate cancer monitoring has relied heavily on routine follow-up biopsies, which can cause discomfort and complications. The UCLA team found that advanced MRI scans can often safely replace these invasive procedures, providing high-resolution visualization of prostate tissue and detecting subtle changes in tumor characteristics with greater precision.
"This represents a major advancement in the management of prostate cancer," said Dr. Leonard Marks, chair of urology at the David Geffen School of Medicine at UCLA and senior author of the study. "By combining MRI-guided diagnosis with selective focal therapy, we can offer men a more personalized approach that helps avoid unnecessary procedures while better predicting who will benefit from extended surveillance."
Impressive Accuracy of MRI Technology
The study revealed that MRI technology was remarkably accurate in identifying cancers suitable for active surveillance, correctly predicting stable disease in 90-95% of men with low-risk cancer and 70% of those with intermediate-risk tumors. This level of diagnostic precision enables clinicians to better stratify patients, ensuring active surveillance is reserved for those with truly indolent disease.
The reliability of MRI-based monitoring also reduced the necessity for repeat biopsies, allowing many men to avoid the discomfort and risks associated with repeated tissue sampling. This improvement in patient experience potentially limits complications such as infection or bleeding.
Focal Therapy's Impact on Treatment Outcomes
Beginning in 2016, men showing increased risk profiles or evidence of progression were offered focal therapy, which about 25% accepted. Unlike whole-gland treatments, focal therapy selectively targets tumor tissue within the prostate using heat, cold, or electricity to kill cancer cells while sparing surrounding healthy areas.
The results were striking: 84% of men receiving focal therapy avoided subsequent radical treatments like surgery or radiation, compared to only 46% in the group that did not undergo the therapy. This significant difference underscores focal therapy's potential to mitigate overtreatment and its debilitating side effects, which can include urinary incontinence and sexual dysfunction.
"Although the numbers for the focal therapy group are small and the follow-up was relatively brief, the near-term advantage of focal therapy in avoiding surgery or radiation is clear," Dr. Marks noted.
Psychological Benefits of Advanced Monitoring
Beyond clinical metrics, the study observed a decrease in patients discontinuing active surveillance due to anxiety. This suggests that confidence in the safety and accuracy of MRI-driven surveillance protocols alleviates psychological distress, which has often driven early intervention in prostate cancer.
This finding is particularly significant given that prostate cancer remains the most frequently diagnosed non-skin cancer in American men, affecting approximately one in eight over their lifetime. While the majority of these cancers are indolent and progress slowly, anxiety about disease progression often pushes patients toward aggressive treatments despite their potential long-term consequences.
Implications for Future Care
The UCLA study delineates a clear path forward in prostate cancer management, leveraging modern imaging modalities and focal therapy to extend active surveillance eligibility while reducing the physical and psychological burden of overtreatment.
Shannon Martin, lead author of the study and a senior medical student, worked alongside a multidisciplinary UCLA team of urologists, radiologists, and researchers on this progressive work. Their collaborative effort exemplifies the fusion of cutting-edge imaging, minimally invasive treatment, and patient-centered care in modern oncology.
The researchers caution that their findings stem from a single institution with specialized expertise and resources, which may limit immediate applicability across varied clinical environments where access to high-quality MRI and focal therapy expertise could vary. They advocate for broader studies and the development of standardized protocols to validate and extend these benefits to a wider population.
Supported by grants from the National Cancer Institute and the Jean Perkins Foundation, this research offers some of the strongest evidence yet that active surveillance, when guided by modern imaging and minimally invasive treatments like focal therapy, can safely be expanded to more patients with prostate cancer.
