Focal therapy offers a middle ground therapy for men with localized prostate cancer. It uses ablation, or tissue destruction, to target the area that contains the index lesion. Men who have focal therapy will continue to be monitored after treatment.
Focal therapy is a treatment for prostate cancer of low to intermediate aggressiveness that is completely contained (localized) within the prostate.
For many years there have been two main approaches to managing localized prostate cancer. The first is active surveillance or “watchful waiting.” In cases of older men or low-risk patients, regular medical tests are conducted to make sure the cancer isn’t spreading. No other action is taken because the cancer is stable or growing so slowly it won’t cause problems right away. If tests show the cancer is spreading, treatments can begin. Of those men assigned to active surveillance, about one-third will eventually need to have surgery or radiation.
The second approach to treating localized prostate cancer has been the use of radiation or surgery. This is effective for removing any tumors present but is typically associated with side effects in the urinary, sexual, and bowel function. Two common side effects include loss of control over urinary functions (incontinence) and erectile dysfunction
Focal therapy offers a middle-ground treatment. The idea behind focal therapy is to preserve these functions while still treating the cancer effectively. Focal therapy concentrates on treating “the index lesion,” which is usually defined as a tumor visible on MRI of low or favorable intermediate grade Even though many cases of prostate cancer have more than one tumor site, some researchers believe that the index lesion is what drives and predicts how any particular cancer will progress. If growth of the index lesion can be controlled with focal therapy, the thought is that the cancer as a whole can be managed safely while minimizing side effects.
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Focal therapy uses ablation, which is the use of extreme temperatures to destroy tissue. In focal ablation, the area of the prostate that contains the index lesion is targeted, rather than treating the entire prostate gland. Focal ablation techniques include:
When focal therapy for prostate cancer first began to be used in about 2007, it was only as an alternative to active surveillance in very low-risk patients. Since then, the use of focal therapy has expanded to include those with favorable intermediate risk disease (as defined by the NCCN guidelines). The best candidates have a prostate gland of about 40cc in size or a tumor in the lower half of a larger gland, a single visible tumor on MRI, and the absence of cancer elsewhere in the gland (as proven by biopsies).
In each case, the doctor will consider the patient’s general health and mental outlook, the size and location of the tumors present, and their chances of spreading more. Use of tests such as MRI, ultrasound, and biopsy (tissue samples examined in the laboratory) can help decide if a patient will benefit more from focal therapy or from traditional treatments.
Patients treated with focal therapy still need to be actively monitored afterwards. This includes watching for disease that may have gone undetected, has returned, is spreading, or is appearing for the first time. If follow-up tests show that some of the treated cancer still remains, additional ablation, surgery, or radiation may be needed.
While the use of focal therapy for localized prostate cancer appears to be a promising development in a number of ways, it is still considered investigational and not yet part of standard therapy. There are a number of reasons for this, as follows:
Last reviewed by a Cleveland Clinic medical professional on 01/26/2021.
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