Focal Therapy for Cancer

What is focal therapy?

Focal therapy is a specialized cancer treatment. It is notably used in the treatment of prostate cancer. uses a precision technique to inhibit cancer, while sparing nearby critical structures. In prostate cancer treatment, focal therapy helps protect areas responsible for urinary continence and erectile function.

Multiple energy types are available for focal therapy. At UF Health, we offer:

• Focal cryoablation, sometimes called cryotherapy
• Irreversible electroporation ablation, also known as IRE
• High-intensity focused ultrasound

Focal therapy for prostate cancer treatment

Focal therapies, also referred to as ablative therapies, include cryoablation, irreversible electroporation ablation, and high-intensity focused ultrasound (HIFU,) and limit treatment to the cancer's focal location. Focal therapy carries fewer side effects than other non-focal prostate cancer treatment options. The prostate cancer doctors at UF Health are experts in using these therapeutic treatments that target only the cancer, and not the whole prostate gland.

Selection of appropriate, low-risk patients is essential because less therapy may not be adequate to control higher-volume or high-risk prostate cancer. Other concerns regarding focal therapy include targeting the tumor within the prostate accurately, identifying other areas of cancer within the prostate, and offering more effective management compared with active surveillance.

UF Health Urology: Take control of prostate cancer & understand focal therapy

Discover the importance of prostate cancer screening and explore the latest leading-edge treatments for prostate cancer, including noninvasive options like focal therapy.

Who is a candidate for focal therapy?

A good candidate for focal therapy treatment is someone who:

• Greater than a 10 year life expectancy
• Intermediate risk prostate cancer
• Small cancer volume
• Ability to achieve an adequate margin without damaging critical structures
• Planning a prostate biopsy such as a transperineal prostate biopsy
• Patient compliance with surveillance

Patients considering focal therapy will also undergo a specialized prostate MRI called micro-ultrasound.

The above images demonstrate a tumor imaged with 3 separate imaging modalities, enabling us to carefully delineate the tumor margins prior to treatment.

What are the side effects of focal therapy for prostate cancer?

In general, the side effects of focal therapy in the prostate are not as severe as those of whole-gland therapy (including radical prostatectomy and radiation). This is because nerves and muscles responsible for urinary continence and erectile function are avoided. An important consideration of focal treatment is that cancer control is not as good as whole gland therapy. However, prostate cancer can often grow slowly, allowing us to catch recurrences and intervene if needed.

How successful is focal therapy for prostate cancer?

The need for additional treatment (such as radical prostatectomy or radiation therapy) is about 30% at seven years. Additional focal therapies may be used to ablate prostate cancer recurrences; however, this is not traditionally performed more than once prior to referring patients for whole gland therapy.

How is a patient monitored after focal therapy?

Follow-up after focal therapy is important as some men will have a cancer recurrence. PSA is an unreliable marker, as the remaining non-ablated portion of the prostate continues to produce PSA . At the University of Florida, patients are followed with novel urinary biomarkers, imaging and biopsy 6-12 months following focal therapy to ensure successful treatment. Patients also obtain a surveillance biopsy 18-24 months after treatment to ensure no prostate cancer recurrence.

What happens if prostate cancer comes back?

As long as patients continue to be surveyed, the prostate cancer recurrences are found early and can be treated. Salvage treatment options include repeat focal therapy, surgery and radiation. While side effects are similar to those who have primary treatment, the extent of initial focal therapy, and baseline urinary and erectile function all influence outcomes.

Learn about UF Health urologic oncology and how our expert team of prostate cancer physicians can help you.

What other cancers can be treated with focal therapy?

Focal therapy is most commonly used to treat prostate cancer, but it is also becoming an effective treatment option for several other types of cancer, including:

• Breast cancer
• Kidney cancer
• Liver cancer
• Lung cancer

Although treatment methods vary by cancer type, patients who are good candidates for focal therapy often share similar characteristics. In general, candidates may have:

• A life expectancy of more than 10 years
• Low- to intermediate-risk cancer
• Small, localized tumors with a low overall tumor burden
• The ability and willingness to participate in ongoing follow-up and surveillance

Focal therapy is designed to precisely target cancerous tissue while preserving as much healthy tissue as possible. Because of this tissue-sparing approach, many patients experience benefits such as fewer side effects, faster recovery, and preservation of organ function.

For example:

• Breast cancer patients may be able to avoid a radical mastectomy, preserving healthy breast tissue and potentially reducing the need for reconstructive surgery
• Kidney cancer patients may lower their risk of chronic kidney disease while protecting nearby organs and healthy kidney tissue
• Liver cancer patients, especially those with underlying liver disease, may benefit from preserving healthy liver tissue and minimizing damage to surrounding structures
• Lung cancer patients may experience a lower risk of fibrosis and avoid more invasive procedures, such as partial or full lobectomy

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