Focal Therapy for Prostate Cancer

Focal therapy for prostate cancer is a specialized type of treatment that targets only the tumor and protects as much healthy tissue as possible. It has a lower risk of side effects compared to traditional forms of prostate cancer therapy. The tumor must be only in your prostate (local), and usually limited to one area. That means it hasn’t spread (metastasized) to other tissues or organs around your prostate.

Focal therapy is a “middle ground” alternative to other types of prostate cancer treatments, like:

• Active surveillance
• Radiation therapy
• Surgery (radical prostatectomy)

It’s not as common as these treatments. But it’s becoming a more popular option for those who are good candidates.

Focal therapy for prostate cancer is also called:

• Prostate cancer focal therapy
• Prostate cancer ablation

What is a focal therapy?

It’s a minimally invasive option to treat some types of prostate cancer. The different types of focal therapies for prostate cancer include:

• Cryotherapy: A healthcare provider freezes the tumor with cold gases.
• Focal laser ablation (FLA): Heat from a laser destroys tumor cells.
• High-intensity focused ultrasound (HIFU): Heat from high-frequency sound waves destroys tumor cells.
• Irreversible electroporation (IRE): A provider uses electrodes around the tumor to deliver an electric shock that destroys tumor cells.
• Transurethral ultrasound ablation of the prostate (TULSA): Heat from sound waves destroys tumor cells.

Researchers are also conducting clinical trials to see whether water vapor (steam) is a possible focal therapy.

Why not remove the prostate?

Focal therapy can treat small prostate tumors that don’t affect the whole prostate. It also has a lower risk of side effects than removing your whole prostate or radiating your whole prostate.

Over 8 out of 10 people have worsened erectile dysfunction after prostate removal. Up to 2 out of 10 have bothersome urinary incontinence after radical prostatectomy. These side effects are significantly less common with focal therapy because providers don’t treat the entire prostate.

Who is eligible?

You’re a good candidate for focal therapy if:

• You have intermediate-risk prostate cancer that has a low risk of spreading. This means your PSA levels are between 10 and 20, the cancer is grade 2 or 3 and fewer than half of biopsies are positive.
• The cancer only affects a limited area of your prostate.
• The tumor isn’t near your urinary sphincter and doesn’t involve the urethral lining.

Active surveillance is better for low-risk prostate cancers. Surgery or radiation therapy — treatments that involve the whole gland — are excellent options for higher-risk prostate cancers. They’re also good options for those who don’t want to undergo surveillance following focal therapy.

What happens during focal therapy for prostate cancer?

You may first need several tests and imaging studies. These help your healthcare provider determine your treatment options. They may include:

• MRI to get detailed images of your prostate and the surrounding areas
• MRI-guided prostate biopsy to help diagnose and stage prostate cancer
• Mapping biopsy to map the boundaries (margins) of the tumor
• PSMA PET scan to detect prostate-specific membrane antigen and see if cancer has spread to other parts of your body

Each focal therapy works a little differently. Your provider will tell you what to expect based on which type you need. In general, your provider will:

1. Give you general anesthesia so you’ll sleep through the procedure and you won’t feel any pain.
2. Insert the device into your prostate either through your rectum or urethra, or with a needle through the skin between your genitals and anus (perineum).
3. Use real-time imaging tests to precisely guide the device to the tumor.
4. Target the tumor with heat, cold or electricity to damage and destroy its cells.

Focal therapy takes about two hours, depending on the size of your prostate and the cancer. Most people go home the same day.

How successful is it?

The outcomes and success of focal therapy vary according to:

• The type of focal therapy
• Where the tumor is located on your prostate
• The likelihood that the tumor will spread
• The experience of the surgeon

Experts consider focal therapies less effective than whole-gland therapies like radiation and surgery for higher risk prostate cancer.

Talk to your healthcare provider. They can help you understand which type of treatment might be right for you and set realistic goals and expectations.

What are the side effects?

Focal therapy has a lower chance of urinary incontinence and erectile dysfunction. But problems with peeing and problems getting an erection are still possible. Other possible side effects include:

• Pain around your prostate or testicles
• Urinary tract infections (UTIs)
• Blood in your pee

Other disadvantages or risks include:

• Some cancerous cells may remain, which may cause prostate cancer to come back (recur).
• You may need additional treatments if cancer comes back.
• Not everyone is a good candidate.
• You’ll need more monitoring after treatment, including MRIs and prostate biopsies.

How long will it take for me to feel better?

Most people can resume light activities a few days after focal therapy for prostate cancer. You should completely recover within a few weeks.

Your healthcare provider will insert a temporary urinary catheter after the procedure. It drains your pee while your prostate and urethra heal. You may need to use a catheter for up to a week.

Is there anything I can do to make focal therapy for prostate cancer easier on me?

The following tips can help you feel better as you recover:

• Get a lot of rest.
• Avoid intense physical activities, like running, heavy lifting and riding a bike.
• Avoid all sexual activity for a few days to let your prostate heal.
• Drink plenty of water.

When should I call my healthcare provider?

Call your healthcare provider if you have any signs of infection after focal therapy. These may include:

• Trouble peeing or inability to pee
• Severe pain
• A fever higher than 101 degrees Fahrenheit (38 degrees Celsius)
• Chills
• Diarrhea

Your provider will monitor you closely for months or years. This includes testing and looking for signs of cancer that:

• Didn’t show up on tests or imaging before
• Wasn’t completely destroyed by focal therapy
• Has come back
• Is spreading

You may need additional treatment — including radiation or surgery — if tests show there’s still cancer in your prostate.