Navigating Focal Therapy for Prostate Cancer: Contemporary Perspectives and Future Trajectories in the Canadian Context

Objective: This article equips Canadian urologists with the latest advancements in focal therapy (FT) principles and outcomes while providing an overview of its current landscape in Canada, including challenges and future directions. Methods: We conducted a nonsystematic review of the literature on FT in urology and prostate cancer (PCa), focusing on Canadian-led studies. Articles were identified using PubMed, MEDLINE, and Google Scholar and selected based on relevance and originality. The final search was completed in April 2024. A survey was also conducted among Canadian urologists and radiologists practicing FT. It covered their experiences, access to technology, implementation challenges, and reimbursement policies. Data were collected via video calls, phone calls, or email, and responses were reported anonymously. Results: Fourteen Canadian urologists and radiologists performing FT were contacted, and 12 participated in this study. Despite the increasing adoption of FT by Canadian urologists, nationwide implementation remains limited due to financial constraints and resource shortages. This has restricted the availability of FT for Canadian men with PCa compared with their American and European counterparts. Only two provinces-Saskatchewan and Alberta-currently have billing codes for FT, forcing patients elsewhere to either join clinical trials or pay out of pocket. To close this care gap, equitable health care coverage and integration of FT into standard treatment options are essential. Conclusion: The quality of research in FT is showing promising improvements, with several clinical trials currently underway that may pave the way for broader acceptance within clinical guidelines by multiple urological societies. Although Canada has been slower to adopt FT compared with other parts of the world, Canadian urologists continue to advocate for provincial health care coverage to ensure that this innovative technology becomes accessible to Canadian patients.