Advanced imaging and targeted therapy help men with prostate cancer safely defer surgery and radiation therapy

A new study led by UCLA Health Jonsson Comprehensive Cancer Center shows that using advanced MRI imaging and targeted focal therapy can help many men with low- to intermediate-risk prostate cancer safely stay on active surveillance long-term, avoiding follow-up biopsies and delay, or even avoid, invasive treatments such as surgery or radiation. 

Researchers found that a routine follow-up biopsy, previously considered essential, can now be replaced in most instances by MRI. Among men with slightly more aggressive cancer, those who had focal therapy were much more likely to avoid surgery or radiation, 84%, compared to 46% without therapy.

Recently published in the Journal of Urology, the findings add to growing evidence that these tools make active surveillance, close monitoring rather than immediate treatment, safer, more personalized and less stressful for patients.

“This represents a major advancement in the management of prostate cancer,” said Dr. Leonard Marks, professor and deKernion Endowed Chair in 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. This strategy not only helps avoid unnecessary procedures, but also gives us a better way to predict who will benefit from extended surveillance, potentially improving quality of life and reducing side effects without compromising safety.”

Prostate cancer is the most common non-skin cancer among American men, with about one in eight diagnosed during their lifetime. Many are low risk and grow so slowly they may never cause symptoms. Despite growing acceptance of active surveillance, many still choose surgery or radiation out of fear the cancer could become dangerous, risking long-term side effects such as incontinence or sexual dysfunction. To strengthen confidence in active surveillance and reduce overtreatment, the UCLA Health team evaluated whether adding MRI-guided biopsy and focal therapy could make surveillance safer and easier for patients to sustain.

MRI and MRI-guided biopsies offer a clearer view of prostate cancer, enabling better tracking of changes over time. When active surveillance began, these tools weren’t widely available, so physicians relied on ultrasound-guided biopsies, which could miss important tumors or overtreat slow-growing ones.

Focal therapy is a minimally invasive procedure that targets only the tumor instead of the whole prostate, using imaging guidance such as MRI to accurately locate and guide the treatment. The study analyzed data from 869 men enrolled in UCLA Health’s active surveillance program between 2010 and 2022, the largest long-term study of men with prostate cancer monitored with MRI and MRI-guided biopsy for up to 12 years.

All participants had an MRI-guided biopsy at the start showing low- to intermediate-risk prostate cancer, and they stayed in the program for at least one year. Starting in 2016, some men were offered focal therapy either because they had slightly higher-risk cancer at diagnosis or because their cancer showed signs of progressing. About a quarter, 99 out of 393 eligible men, chose the treatment.

MRI proved highly accurate in identifying stable cancers, correctly predicting non-progression in 90% to 95% of men with low-risk cancer and 70% with intermediate-risk cancer. Starting surveillance with MRI-guided biopsy allowed doctors to better determine who can safely stay on surveillance. Because MRI is so accurate, many men with favorable results avoided repeat biopsies, reducing physical discomfort and chance of over treatment.

The study also showed fewer patients leaving active surveillance due to anxiety, which researchers link to growing confidence in MRI-based monitoring and surveillance programs.

“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 said. “This study offers some of the strongest evidence yet that active surveillance, when guided by modern imaging and minimally invasive treatments such as focal therapy, can safely be expanded to more patients.”

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