This is what pains me about focal and the GU field and even organizations that standby silent: We learn to maximize benefit and minimize harm through carefully conducted controlled trials. 99% of these tx are done off trial. Most RCTs are negative bc we are wrong often even when ph2 promising. Focal phase 2 trials largely disappointing. Even ignoring that there is a >50% chance these tx harm more than help, but doctors are literally willing to take these pts cash and harm countless men. This is bc: If focal was truly better they are harming millions of men by not answering the question carefully in a trial to change SOC and provide it to all… And if focal is worse they are harming millions of men indefinitely by pretending it helps, bankrupting families, and causing irreversible harm. There are places that have focal tumor boards and the institutions enable it. There is no good data to support using it, let alone pretend you have any clue who it is good for. It’s like having a focal brachy tumor board = anecdotes leading anecdotes. The decay of EBM. Embarrassment for doctors to do off trial, disgrace the field stands by silent while these men are being harmed. If focal is so amazing do the dang RCT to SBRT and mandate it be on trial. Otherwise just admit you happily take cash from patients for a treatment that may ultimately be worse for them than SOC and you have no good data to prove otherwise. Many professions take ppls money. Sad this is rampant in GU. – at Shaker Heights, OH