Eyebrows were recently raised at the widely-publicized phase 2 trial of focal thermal ablation of grade group 2-3 prostate cancer purporting the emergence of a new “safe and effective” treatment. This editorial takes primary issue with the “effective” but also with the “safe.” The key word here is focal. Remember, there was an 88% chance of achieving no persistent grade group 2+ disease at the focal site of ablation. But! 40% of men had persistent grade group 2+ disease somewhere in the prostate, including 59% of men with initial grade group 3 disease. As highlighted previously, this compares to 7-8% of men after prostate SBRT. These authors also point to prostate SBRT achieving similar rates of toxicity without the added requirement of serial biopsies. When it comes to safety, especially considering the median age of 63, that is yet to be seen with observing how a substantial number of these men fare with the inevitable definitive radiation or surgery to come now post-ablation. | Hall, Eur Urol 2022


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