Focal Therapy
Focal therapy for prostate cancer has divided physicians, with some considering it a viable alternative to traditional treatments and others viewing it as experimental. A recent UK study found that 10 years after treatment, only 0.1% of patients treated with focal therapy had died of prostate cancer, comparable to survival outcomes for standard treatments. However, many specialists would like to see more long-term data and clearer evidence for its benefits from randomized trials directly compari
Focal therapy for prostate cancer has divided physicians, with some considering it a viable alternative to traditional treatments and others viewing it as experimental. According to a recent UK study, 10 years after treatment, only 0.1% of patients treated with focal therapy had died of prostate cancer, comparable to survival outcomes for standard treatments.
The American Urological Association says focal therapy is still experimental, and it should be performed only as part of studies and in prospective registries. However, many leading cancer centers and independent doctors offer focal therapy, and patients who choose it express great satisfaction with it, even though commercial insurance often doesn’t cover it.
What is focal therapy?
Focal therapy comprises a series of Food and Drug Administration-authorized technologies that destroy cancer tissue. The most popular methods - cryotherapy, laser ablation, and high intensity focused ultrasound (HIFU) - have decades of history, and the choice of which to use typically depends on the shape and location of the lesion. The following table compares the popularity of these methods over time:
| Method | 2010 | 2023 |
|---|---|---|
| Cryotherapy | 80% | 20% |
| Laser ablation | 45% | |
| HIFU | 35% |
Under the AUA guidelines, about 10% to 20% of prostate cancer cases would qualify for focal therapy as part of studies. However, uptake remains low, with recent data showing that in the US, 1.3% of prostate cancer patients received focal therapy.
An experimental treatment
Skeptics raise concerns about the rigor of data on focal therapy's ability to effectively treat cancer, the rate of side effects, and the outcomes of each of the technologies. According to Tyler Seibert, an associate professor at the University of California, San Diego, focal therapy needs to be compared directly with established treatments in a head-to-head randomized trial to assess whether it has better outcomes or the same outcomes with a more favorable side-effect profile.
Some focal therapy providers bemoan the fact that most registries group together all focal therapy methods as one treatment, making it hard to discern which has better outcomes or fewer side effects. To address this, Sonablate has launched its own registry to track the outcomes of its HIFU device.
Focal therapy is typically a one-and-done treatment that can take anywhere from 40 minutes to a couple of hours. Patients are monitored through blood testing, MRIs, and sometimes biopsies after the treatment. If cancer appears in other areas of the prostate, further focal therapy sessions can be appropriate, though if it recurs in the area that was treated, radiation or surgery is usually recommended. As Abhinav Sidana, a urologic oncologist and the director of focal therapy at the University of Chicago School of Medicine, notes, an average-skilled surgeon doing focal therapy will end up having better functional outcomes than sometimes even the most skilled prostatectomist.
