What if I told you that after focal therapy, a normal PSA and a clean MRI can still mean prostate cancer is hiding in plain sight?

That’s the moment in this conversation that makes you stop—and rethink everything you’ve been told about “success” after focal therapy.

In this episode, we’re joined by Abhinav Sidana, MD, MPH, Associate Professor of Urology and Director of Prostate Cancer at University of Chicago Medicine, a nationally recognized urologic oncologist, clinical trial leader, and one of the architects shaping the future of focal therapy. Dr. Sidana has trained at AIIMS, Johns Hopkins, NIH, and now leads one of the most rigorous focal therapy programs in the country—backed by over 100 peer-reviewed publications and multiple active clinical trials.

This is not a sales pitch for focal therapy. It’s a clear-eyed look at what works, what doesn’t, and what we still get wrong.

In this episode, you’ll learn:

✅ Why MRI made focal therapy possible—and why it can still miss clinically significant disease

✅ How biopsy strategy—fusion, mapping, or transperineal—directly affects recurrence risk

✅ Why PSA is an unreliable signal after focal therapy—and what actually predicts failure

✅ How short-term ADT may expand focal therapy to larger or higher-risk tumorsIf you’re a patient, clinician, or researcher navigating prostate cancer decisions, this episode will fundamentally sharpen how you think about focal therapy—and its limits.

00:00 Can MRI and PSA Miss Significant Cancer After Focal Therapy?

04:00 Who Is a Good Candidate for Focal Therapy?

06:30 Mapping Biopsies vs MRI Fusion Biopsies

09:30 Transperineal vs Transrectal Biopsies

11:00 What Is IRE (NanoKnife)?

14:30 Who Is NOT a Candidate for Focal Therapy?

18:00 Vapor Therapy & TULSA Pro

23:00 Should Doctors Use Multiple Focal Therapy Technologies?

25:30 Can Higher-Risk Prostate Cancer Be Treated with Focal Therapy?

34:00 Does the Type of Energy Matter?

37:00 Combining ADT with Focal Therapy

40:30 How Tumor Size Impacts Eligibility

45:30 Why MRI and PSA Are Imperfect After Treatment

49:30 What Is PSA Recurrence After Focal Therapy?

53:30 The Future of MRI, AI, and Surveillance

57:30 Do Patients Need Repeat Biopsies Forever?

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⚠️ Disclaimer

This podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.