Surgery and radiotherapy treat the whole prostate. For some men, the cancer is found in only one small area of the gland. Focal therapy aims to treat just that area, leaving the rest of the prostate, and the nerves and muscles around it, largely untouched. The goal is to control the cancer while reducing side effects.
What focal therapy means
Focal therapy is a general term for treatments that target a specific part of the prostate. It has become possible because modern mpMRI scans and targeted biopsies can show where a cancer sits with much greater accuracy than before.
How HIFU works
HIFU stands for high-intensity focused ultrasound. It is the most widely used focal treatment in the UK.
- A probe is placed in the back passage under general anaesthetic.
- The probe focuses ultrasound waves on the target area, heating the tissue to a high temperature and destroying the cancer cells.
- The surgeon plans the treatment using MRI and ultrasound images, so that a margin of healthy tissue around the cancer is also treated.
The procedure usually takes a couple of hours, and most men go home the same day or the next morning. A catheter is often needed for a few days.
Other focal treatments
Other techniques include:
- Cryotherapy: freezing the cancer cells.
- Irreversible electroporation: using electrical pulses to damage cells, sometimes called NanoKnife.
- Focal laser ablation: using laser energy guided by MRI.
These are available in fewer centres and are often offered as part of studies. Each has its own pattern of side effects and recovery, so it is worth asking how much experience a centre has with the specific technique it offers.
Who may be suitable
Focal therapy may be considered for men who:
- have intermediate-risk cancer in one area of the prostate
- have cancer that can be clearly seen on MRI and confirmed by targeted biopsy
- have no evidence of spread outside the prostate
- understand that longer-term evidence is still developing
It is usually not suitable for men with cancer spread throughout the prostate or high-risk disease.
Possible benefits
Compared with treating the whole gland, focal therapy may offer:
- a lower risk of urinary leakage
- a lower risk of erection problems
- a quicker recovery
- the option of further treatment later, including repeat focal therapy, surgery or radiotherapy
Possible drawbacks
There are also important considerations:
- Cancer elsewhere: because the rest of the prostate is left in place, cancer may develop or be found in another area.
- Retreatment: some men need a second focal treatment or a whole-gland treatment later.
- Follow-up: regular PSA tests and MRI scans, and sometimes biopsies, are needed for many years.
- Evidence: results over five years and beyond are encouraging, but there is less long-term data than for surgery or radiotherapy.
NICE guidance on prostate cancer advises that focal therapy should be offered within a clinical trial or with careful data collection.
Treatment after focal therapy
If cancer returns after focal therapy, surgery or radiotherapy can usually still be offered. Surgery after HIFU can be more technically demanding because of scar tissue, so experience matters. Our robotic prostatectomy page explains the operation.
Comparing your options
Focal therapy is one of several choices for localised cancer. Our guides to surgery or radiotherapy and active surveillance explain the alternatives. Prostate Cancer UK also has a detailed guide to HIFU.
Is focal therapy right for you?
The right choice depends on where your cancer is, its grade and how you balance the chance of retreatment against the possible reduction in side effects.
Professor Prokar Dasgupta can review your MRI and biopsy results and discuss all suitable options at The London Clinic. Please contact the clinic to arrange a consultation.