What is focal therapy?
Focal therapy is a specialized form of prostate cancer treatment that seeks to treat prostate cancer and a margin of normal tissue while sparing the surrounding critical structures responsible for urinary continence and erectile function. There are multiple different energy modalities available for focal therapy, such as: cryoablation, irreversible electroporation, high-intensity focused ultrasound and focal laser ablation. Less important than the energy used is localizing the tumor and use of appropriate margins.
Who is a candidate for focal therapy?
- Greater than 10 years life expectancy
- Intermediate risk prostate cancer
- Small cancer volume
- Ability to achieve an adequate margin without damaging critical structures
- Planning 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?
In general, side effects of focal therapy are not as severe as with whole gland therapy (surgery and radiation). This is because nerves and muscles responsible for urinary continence and erectile function are avoided. An important consideration of focal therapy 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?
The need for additional treatment (such as surgery or radiation) is about 30% at 7 years. Additional focal therapy procedures may be performed to ablate cancer recurrences; however, this is not traditionally performed more than once prior to referring patients for whole gland therapy.
How is one followed 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 cancer recurrence.
What happens if cancer comes back?
As long as patients continue to be surveyed, the 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 obtaining primary treatment, the extent of initial focal therapy, baseline urinary and erectile function all influence outcomes.