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.
Journal of endourology. 2024 Nov 29 [Epub ahead of print]
Charles Hesswani, Pier-Paolo Avolio, Alexis Rompre-Brodeur, Sangeet Ghai, Maurice Anidjar, Adam Kinnaird, Joseph Chin, Nathan Perlis, Mostapha Soytas, Miles Mannas, Ardalanejaz Ahmad, Lawrence Klotz, Simon Tanguay, Wassim Kassouf, Victor McPherson, Armen Aprikian, Peter Pinto, Rafael Sanchez-Salas
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA., Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Canada., Department of Medical Imaging, University Health Network, Toronto, Canada., Division of Urology, University of Alberta, Edmonton, Canada., Division of Urology, Department of Surgery, Western University, London, Canada., Division of Urology, Department of Surgery, University Health Network, Toronto, Canada., Department of Urologic Sciences, University of British Columbia, Vancouver, Canada., Section of Urology, Department of Surgery, Manitoba, Canada., Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Canada.