Introduction
Prostate cancer affects many men worldwide. Treatment options have changed a lot in recent years. Traditional treatments like surgery and radiation work well but can cause side effects. Focal therapy offers a middle option. It targets just the cancer while sparing healthy tissue. This guide explains what focal therapy is, who can benefit, and what you need to know before choosing this option.
What is Focal Therapy?
Focal therapy targets specific areas of cancer in the prostate. It destroys cancer cells while saving the healthy parts. This differs from whole-gland treatments like surgery or radiation. Those treatments affect the entire prostate.
Dr. Mark Emberton from University College London calls focal therapy “the middle ground between watching and waiting and radical treatment. It offers cancer control with fewer side effects.”
The “Male Lumpectomy” Approach
Think of focal therapy as similar to breast lumpectomy. Instead of removing the whole organ, doctors treat just the tumor and a small rim of tissue around it. This keeps most organ function intact while fighting the cancer.
Key Benefits of Focal Therapy
- Targets only the cancer areas
- Saves healthy prostate tissue
- Keeps urinary and sexual function working
- Allows for more treatment later if needed
Who Can Get Focal Therapy?
Not every man with prostate cancer can have focal therapy. Doctors choose patients carefully.
Good Candidates Include
- Men with cancer that hasn’t spread beyond the prostate (stages T1c-T2a)
- Those with a Gleason score of 7 or less (3+4)
- Cancer in one area of the prostate or one main tumor with tiny ones nearby
- PSA level lower than 15 ng/mL
- No cancer growth outside the prostate capsule
- Men who want to avoid side effects of major treatments
Dr. Hashim Ahmed from Imperial College London says: “Picking the right patients is key to success with focal therapy. We must make sure the cancer type fits this approach.”
Tests You’ll Need First
Before trying focal therapy, you’ll likely need:
- MRI scan: Shows where tumors are located
- Targeted biopsies: Takes samples from areas that look suspicious
- Systematic biopsies: Sometimes needed to check the whole prostate
- PSA blood test: Sets a baseline for future checks
Types of Focal Therapy
Doctors use several types of focal therapy. Each works differently and has its own pros and cons.
High-Intensity Focused Ultrasound (HIFU)
HIFU uses sound waves to heat and kill cancer cells.
How it works: Sound energy focuses on a small area. This heats tissue to 80-90°C, killing cells in that spot.
Benefits:
- No cuts needed
- Very precise
- Can be done again if needed
- Usually done as an outpatient visit
Things to consider:
- Not right for all prostate sizes
- May miss some tumors in front part of prostate
- Still gathering long-term results
A study in 2018 found that 88% of men didn’t need major surgery within 5 years after HIFU.
Cryotherapy
Cryotherapy freezes cancer cells to kill them.
How it works: Thin needles go into the prostate. They circulate very cold gas to freeze tissue to -40°C. Then they thaw it. This cycle kills the cancer cells.
Benefits:
- Used for many years with good data
- Works for different prostate sizes
- You can see the ice forming during treatment
Things to consider:
- Needs needle insertion
- Small risk of “cryo-shock” (rare but serious)
- Needs warming device to protect the urethra
Focal Laser Ablation (FLA)
FLA uses laser heat to destroy cancer cells.
How it works: A thin laser fiber goes into the prostate using MRI guidance. It heats the tumor tissue.
Benefits:
- Very precise
- Doctors monitor temperature in real time
- Minimal harm to nearby tissues
- Quick recovery
Things to consider:
- Less long-term data than other methods
- Needs special MRI equipment
- Not found in all hospitals
Irreversible Electroporation (IRE)/NanoKnife
IRE uses electrical pulses to create tiny holes in cancer cell membranes. This kills the cells.
How it works: Doctors place electrodes around the tumor. These deliver brief electrical pulses that disrupt cell membranes without heat damage.
Benefits:
- Spares nerves, blood vessels, and ducts
- Clear border between treated and untreated tissue
- Good for tumors near important structures
Things to consider:
- Newer with less long-term data
- Requires full anesthesia with muscle relaxants
- Complex to perform
Photodynamic Therapy (PDT)
PDT combines special drugs with light to kill cancer cells.
How it works: You get a light-sensitive drug through an IV. This drug builds up in cancer cells. Laser light then triggers the drug to make oxygen that kills the cells.
Benefits:
- Targets cancer cells specifically
- Minimal effects on nearby areas
- Can be done more than once
Things to consider:
- Skin and eyes remain sensitive to light for a while
- Not widely available
- Limited data on long-term success
What Happens During Treatment
Each focal therapy type has its own steps. But most follow a similar process.
Before Treatment
- Detailed scanning: Doctors confirm exactly where your tumor is
- Health check: Makes sure you’re ready for anesthesia
- Medicine changes: You may need to stop blood thinners
- Bowel prep: Sometimes needed for better imaging
During Treatment
- Anesthesia: You’ll get either general or spinal anesthesia
- Positioning: You’ll lie on your back with legs raised
- Real-time guidance: Ultrasound or MRI helps guide the doctor
- Treatment: The doctor applies the energy source to your tumor
- Monitoring: Staff checks treatment coverage and vital signs
After Treatment
- Recovery: Usually brief, with many going home the same day
- Catheter: You may need a urine tube for 1-7 days
- Medicines: Pain relief and antibiotics as needed
- Activity limits: Usually minimal, with normal activities resuming within 1-2 weeks
How Well Does It Work?
Research on focal therapy continues to grow. Evidence shows promise for men with the right cancer type.
Cancer Control Results
Studies show these outcomes after focal therapy:
- No significant cancer found: 71-92% after 3 years
- No need for major treatments: 80-91% after 5 years
- Cancer survival rates: Similar to surgery in well-chosen patients
A 2019 review found that across different focal therapy types, 83.3% to 96.3% of men remained free of treatment failure after 5 years.
Effects on Daily Life
Compared to surgery or radiation, focal therapy typically shows:
- Urinary control preserved: 95-100% of men
- Sexual function preserved: 70-90% of men
- Bowel function: Little to no change
Dr. Thomas Polascik of Duke University notes: “Keeping quality of life, especially urinary control and sexual function, is a big advantage of focal therapy for the right patients.”
Retreatment Rates
- About 10-30% of men need a second focal treatment
- 5-20% eventually need surgery or radiation within 5 years
Follow-up After Treatment
Close monitoring is essential after focal therapy.
Typical Follow-up Plan
- PSA tests: Every 3 months for a year, then every 6 months
- MRI scans: At 6-12 months after treatment, then yearly
- Biopsies: At 12 months post-treatment, then as needed
- Quality of life checks: Tracking urinary, sexual, and bowel function
Understanding PSA After Focal Therapy
Your PSA won’t drop to zero after focal therapy because healthy prostate tissue remains. Doctors look for:
- Stable PSA within a normal range
- No steady rise in PSA
- How fast PSA changes over time
Comparing Your Options
Focal Therapy vs. Surgery
AspectFocal TherapySurgeryCancer controlGood for select patientsExcellent for localized cancerRisk of urine leakage0-5%10-20%Risk of erection problems10-30%30-70%Recovery timeDays to weeksWeeks to monthsRisk of needing more treatment10-30%5-10%Long-term dataLimited (10-15 years)Extensive (20+ years)
Focal Therapy vs. Radiation
AspectFocal TherapyRadiationCancer controlGood for select patientsExcellent for localized cancerTreatment sessionsUsually oneMultiple over weeksUrinary symptomsMild, short-termCan last longerRectal problemsRare5-15%Options if cancer returnsSeveral choicesLimited by radiation limitsLong-term dataLimitedExtensive
Focal Therapy vs. Active Surveillance
AspectFocal TherapyActive SurveillanceCancer treatmentImmediateDelayed until growthWorry levelLess anxiety about untreated cancerPossible stress about living with cancerMonitoring neededModerateHigh (frequent biopsies)Risk of cancer growthLowerHigherImpact on daily lifeMinimalMinimal at first
Challenges and Limits
Despite its promise, focal therapy faces several challenges:
Technical Issues
- Multiple tumors: Prostate cancer often occurs in several spots
- Imaging limits: Even the best MRI may miss small tumors
- Treatment borders: Deciding how much tissue to treat
- Different methods: Centers use different techniques
Clinical Challenges
- Limited long-term data: Most studies cover only 5-10 years
- Patient selection: Finding the right candidates remains tricky
- Learning curve: Doctors need special training
- Insurance coverage: Varies widely between countries and plans
Future Developments
The field of focal therapy continues to grow quickly.
New Technologies
- MRI-guided focused ultrasound: Combines real-time imaging with treatment
- Artificial intelligence: Improves tumor detection and planning
- Combined approaches: Using focal therapy with other treatments
- Better imaging: Finding significant cancer more accurately
Current Clinical Trials
Several important studies are now testing focal therapy:
- CHRONOS: Comparing HIFU to surgery
- FORECAST: Tracking results from various focal therapies
- TACT: Testing cryotherapy for medium-risk prostate cancer
- PART: Studying photodynamic therapy for localized cancer
Is Focal Therapy Right for You?
When thinking about focal therapy, ask yourself:
Questions for Your Doctor
- Am I a good candidate for focal therapy?
- How many of these procedures have you done?
- What are my chances of needing more treatment later?
- How will we know if the treatment worked?
- What side effects might I face?
Finding a Good Doctor
Focal therapy requires special skills:
- Look for centers doing many cases (more than 50 yearly)
- Ask about the team’s experience with your chosen method
- Request their success rates
- Consider academic centers with research programs
Dr. André Luis Abreu from USC advises: “Find centers with a team approach to prostate cancer. Look for urologists who work closely with radiologists and pathologists who specialize in prostate cancer.”
Common Questions
Q: Will focal therapy cure my prostate cancer?
A: For the right patients with cancer that hasn’t spread, focal therapy can control cancer well. But we’re still gathering long-term data. Regular check-ups are vital to make sure the cancer stays controlled.
Q: If focal therapy doesn’t work, what can I do?
A: If cancer comes back after focal therapy, you have options. These include more focal therapy, surgery, radiation, or other treatments. Having had focal therapy doesn’t usually limit your future choices.
Q: How soon can I get back to normal after focal therapy?
A: Most men return to normal activities within days to weeks. This depends on the specific method used. Recovery is typically much faster than with surgery.
Q: Will my insurance cover focal therapy?
A: Coverage varies greatly by country, insurance company, and specific technique. Many insurers still consider some focal therapies experimental. Check with your provider and treatment center about costs.
Q: Does age matter when choosing focal therapy?
A: Age is one factor among many. Younger men may benefit from better quality of life but might need more treatments over time. Older men may benefit from shorter recovery compared to major surgery.
Conclusion
Focal therapy offers a middle path between watching and waiting and major treatments for prostate cancer. For the right patients, it can control cancer while preserving quality of life. As technology improves and we gather more data, focal therapy will likely play a bigger role in treating prostate cancer.
Your choice between treatments should be personal. Consider your cancer type, your preferences, and what matters most for your quality of life. A team approach with urologists, radiologists, pathologists, and cancer doctors offers the best foundation for making these complex decisions.