Hospital-Level Variability in the Adoption of Image-Guided Focal Therapy for Localized Prostate and Kidney Cancer

ABSTRACT Background Focal therapy, a minimally invasive procedure, offers targeted treatment for kidney and prostate cancer using image guidance. However, the current institutional landscape of its adoption in localized prostate and kidney cancer remains less understood. This analysis compares its usage between the two cancers to discern health system determinants affecting the adoption of these treatments. Methods The study used data from adult patients with localized prostate and kidney cancer from the National Cancer Database. We calculated adjusted probabilities of focal therapy usage per facility via multivariable mixed-effects logistic regression model with hospital-level random effects. We analyzed inter-hospital variability through ranked caterpillar plots and Spearman correlation coefficient. Results Among 1,559,334 prostate and 425,753 kidney cancer patients, 1.6% and 6.3% received focal therapy, respectively. The inter-hospital variation ranged from 0.13% to 32.17% for prostate cancer and 1.16% to 30.48% for kidney cancer. The hospital-level odds of focal therapy for prostate and kidney cancer were weakly correlated (Spearman's ρ = 0.21; p