br Respondents who were urologic oncology fellowship trained
Respondents who were urologic oncology fellowship trained and more experienced tended to utilize FT in their practice. The regression analysis determined that being in practice for more than 15 years and diagnosing more than 10 CaP patients per month predicted utilization of FT. Man-aging more CaP patients may require being able to offer a variety of treatments. Interestingly, more than half of the participants endorsed using FT if they had better infrastruc-ture and access to a cost-effective method. Hence, we believe as the FT technology advances further, we can anticipate its cost HA Peptide and additional utilization in both smaller and larger centers.
Fig. 1. Practice patterns for focal therapy.
The results of this study should be interpreted with limi-tations in mind, the first being the survey design. As dis-cussed in the methods section, we are unable to determine the exact response rate, as well as the characteristics of those who did not respond to the survey. Those who are fel-lowship trained or those who are at academic centers may
be more likely to complete the survey. The low response rate is a limitation of this study. Thus, this study is subject to a degree of respondent bias since conceivably, those who are more familiar with FT or those more likely to use FT are more likely to submit their opinions. With the potential for a nonrandom sample of respondents, the degree of
generalizability to all urologists is tempered. Nevertheless, this study provides valuable information about the phys-icians’ psyche regarding FT utilization for CaP.
By current opinion, the usage of FT is supported for select men with low- and intermediate-risk CaP. There
are many obstacles, including the lack of long-term evi-dence, infrastructure, and cost-effective access, which prevent more extensive implementation of FT. Index lesion theory has been crucial in the adoption and implementation of FT in the urology world. Cryoabla-tion and HIFU and the most common modalities among those who use FT, and mp-MRI is frequently used in combination with FT. As this is an evolving field,
continuing survey studies will capture the change opin-ions and usage of FT.
 Kim SP, Karnes J, Gross CP, et al. Contemporary national trends of prostate cancer screening among privately insured patients in the United States. Am Soc Clin Oncol 2015.
 Schr€oder FH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet 2014;384:2027–35.
 Ward JF, Jones JS. Focal cryotherapy for localized prostate cancer: a
 Shah TT, Ahmed H, Kanthabalan A, et al. Focal cryotherapy of local-ized prostate cancer: a systematic review of the literature. Expert Rev Anticancer Ther 2014;14:1337–47.
 Calio B, Kasson M, Sugano D, et al: Multiparametric MRI: an oppor-tunity for focal therapy of prostate cancer. Semin Roentgenol.
 Liu W, Laitinen S, Khan S, et al. Copy number analysis indicates mono-clonal origin of lethal metastatic prostate cancer. Nat Med 2009;15:559.
 Muthigi A, Sidana A, George AK, et al. Current beliefs and practice pat-
terns among urologists regarding prostate magnetic resonance imaging and magnetic resonance—targeted biopsy. Urol Oncol, Elsevier. 2016.  Villers A, McNeal JE, Freiha FS, et al. Multiple cancers in the pros-tate. Morphologic features of clinically recognized versus incidental tumors. Cancer 1992;70:2313–8.
 RUIJTER ET, VAN DE K, Christina A, et al. Histological grade het-erogeneity in multifocal prostate cancer. Biological and clinical implications. J Pathol 1996;180:295–9.
 Cheng L, Jones TD, Pan C-X, et al. Anatomic distribution and patho-logic characterization of small-volume prostate cancer (<0.5 ml) in whole-mount prostatectomy specimens. Mod Pathol 2005;18:1022–6.
 Miller G, Cygan J. Morphology of prostate cancer: the effects of mul-tifocality on histological grade, tumor volume and capsule penetra-tion. J Urol 1994;152:1709–13.
 Masterson TA, Cheng L, Koch MO. Pathological characterization of unifocal prostate cancers in whole-mount radical prostatectomy specimens. BJU Int 2011;107:1587–91.
 Stamey TA, McNeal JM, Wise AM, et al. Secondary cancers in the prostate do not determine PSA biochemical failure in untreated men undergoing radical retropubic prostatectomy. Eur Urol 2001;39:22–3.
 Radtke JP, Schwab C, Wolf MB, et al. Multiparametric magnetic res-onance imaging (MRI) and MRI—transrectal ultrasound fusion biopsy for index tumor detection: correlation with radical prostatec-tomy specimen. Eur Urol 2016;70:846–53.
 Turkbey B, Mani H, Aras O, et al. Correlation of magnetic resonance imaging tumor volume with histopathology. J Urol 2012;188:1157–63.