Men missing out on targeted treatments that have fewer side effects

New evidence published today shows focal therapies can be as effective at treating early prostate cancer that's in just one area of the prostate as other treatments like surgery - but with far fewer serious side effects.

Focal therapies are highly precise treatments that target prostate cancer cells directly while sparing the rest of the prostate.

In contrast, both radiotherapy and surgery target the whole prostate along with the cancer cells, either with x-ray beams (radiotherapy) or by removing it entirely (surgery). They're sometimes collectively known as radical treatments.

Yet despite their benefits, focal therapies are much less widely available, with only a few centres currently offering the treatments on the NHS.

The majority of these are in London and southeast England, with not a single centre in Scotland, Wales or Northern Ireland – meaning that thousands of men face the difficult prospect of either paying for treatment or experiencing unnecessary, lifechanging side effects.

That's why we're leading calls for NICE (the organisation that decides what treatments and technologies should be available on the NHS) to review today's evidence and to ensure men across the UK have access to these innovative treatments.

Although the Government recently announced £2.8 million in new funding to expand the provision of focal therapy, without approval from NICE, the treatments can't be offered routinely to all eligible men through the NHS.

Former Prime Minister Lord Cameron, who revealed last year that he had had focal therapy for prostate cancer, highlighted both the growing demand for these treatments and the importance of making them more widely available.

He said: "I was fortunate to be able to benefit from a more advanced focal therapy to treat my cancer that reduced the risk of life-changing side effects. Right now, many men don't have that option, and that's not right.

"Prostate cancer is incredibly common and the way we treat it is changing. We should be doing everything we can to ensure that men across the UK – wherever they live, and whatever their means – can benefit from the latest advances. I hope this new evidence helps speed up wider access, so more men can benefit from the focused treatments that I received."

More targeted approach

Focal therapies include treatments such as high-intensity focused ultrasound (HIFU), which uses high-frequency sound waves to destroy cancer cells, and cryotherapy, which uses extreme cold to do the same.

Because they precisely target individual cancers in the prostate, focal therapies work better for some men than others. They're best suited for men whose prostate cancer is located in just one area of the prostate, but is too high-risk to be monitored through active surveillance.

This targeted approach means the treatments are less likely to damage the surrounding nerves and blood vessels than radical treatments (surgery and radiotherapy) – meaning a lower risk of side effects such as erection and urinary problems.

This is made clear by the research published today, involving nearly 3,500 men who had either HIFU or cryotherapy.

The team at Imperial College London found that the men were no more likely to see their cancer spread than men in other research studies who had surgery or radiotherapy – and no more likely to die from the disease either.

However, the men who had focal therapies were much less likely than those other men to get serious side effects like incontinence, bowel problems or difficulty getting or keeping an erection.

Three years after focal therapy, between 13 and 24% of these men reported erectile dysfunction – less than half the rate seen with radical treatments.

In addition, fewer than 3% of the men needed pads for urine leakage, compared to 5-10% after radical treatment.

Danny, 58, from Nottingham, received focal therapy privately following his prostate cancer diagnosis. said: “Having just taken early retirement, I had great ambitions of travelling, taking up new hobbies and doing charity work. A cancer diagnosis was most definitely not on my bucket list!

"Being diagnosed early gave me more options, and I chose HIFU focal therapy to minimise the risk of side effects. So far, it’s been a complete success. Not only am I back to living my life and making the most of every moment, but I’ve also started running for the first time in my life and along with my wife I've raised nearly £4,000 by completing 131 miles for Prostate Cancer UK’s Run the Month.

"I’m really grateful to have had such a positive experience, and it’s only fair that other men are given the same choice I was. That’s why I’m backing Prostate Cancer UK’s calls for NICE to review these treatments so more men can access them on the NHS.”

Calling for an urgent review

Amy Rylance, our Director of Health Services, Equity & Improvement, said: "Side effects like incontinence or sexual problems can be devastating, and this is the first long-term study that shows many men could avoid them without increasing the risk their cancer could return.

"And it's not just important for individual men. These serious side effects are a major reason we don't yet screen for prostate cancer and reducing them makes it far more likely we can get to a screening programme for all men sooner. That's why all men diagnosed through our TRANSFORM screening study will be able to choose focal therapy if it's appropriate to treat their cancer.

"But without NICE approval, the sad truth is that thousands of men will have to deal with lifechanging side effects simply because of their postcode. That's completely unacceptable, which is why we're calling for an urgent review of these treatments."

Professor Hashim Ahmed, Chair of Urology at Imperial College Healthcare NHS Trust, Professor of Urology at Imperial College London, and Chief Investigator of the TRANSFORM trial said: "I’m delighted that the data finally backs up what we’ve suspected for some time – that focal therapies like HIFU and cryotherapy are comparable to whole-gland treatments in terms of cancer control, but with a fraction of the side effects.

"For a long time, we’ve been in the difficult position of being unable to generate randomised clinical trial evidence for these treatments. This is largely because the benefits of avoiding adverse side effects are so great that many men invited to take part in trials choose not to be randomised, preferring to opt for the treatment that minimises their risk of experiencing them.

"That’s why we’ve been working so hard to generate this real-world evidence so that focal therapies finally have the chance to be approved by NICE and to give men the confidence that they are choosing a treatment that is both targeted and effective."

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