A recent study has suggested that focal therapy for prostate cancer could become a first-line option for treatment of prostate cancer.

The standard treatment for localised prostate cancer is to treat the entire prostate, either by surgically removing the prostate, or to treat the prostate with whole-gland radiotherapy. These treatments are effective, but do cause side-effects such as impairment of urinary, bowel and sexual function.

The side effects of treatment can potentially be reduced by treating only the part of the prostate that has cancer, ie. focal therapy.  Common treatment methods include high intensity focused ultrasound, cryotherapy (using freezing), or irreversible electroporation (using electric pulses).

While focal therapy has been around for some time, what has been lacking is long term data on the effectiveness of treatment. A recent study of patients treated in the United Kingdom with high intensity focused ultrasound (HIFU) or cryotherapy showed promising long term results, with a low rate of deaths due to prostate cancer (0.13%) and distant spread of the disease (3.3%) 10 years after treatment.  The rate of receiving a second focal treatment was 34%, and receiving a whole gland treatment such as whole gland ablation, or radical treatment was 33%.

The authors concluded that focal therapy using up to two sessions of HIFU or cryotherapy could be considered as a first-line treatment for well-selected cases, alongside radical treatment.

We are watching this space closely to see if focal therapy eventually becomes a standard treatment option for patients who have localised prostate cancer. Patients undergoing focal therapy need to be closely followed up after treatment, and they should accept that repeat treatments may be needed later on.

Reference:

Oncological outcomes following focal HIFU and cryotherapy for treatment of nonmetastatic prostate cancer in the United Kingdom: an updated analysis of 3477 patients from the prospective HEAT and ICE registries

https://www.sciencedirect.com/science/article/pii/S030228382602169X#s0095