Focal therapy: the potential advantages and remaining questions

Because focal therapy treats only the cancerous part of the prostate, and not the whole organ, side effects - including effects to urinary and erectile function - are in theory likely to be less severe than with radical treatments like radiotherapy and surgery. The targeted nature of the treatment means that there may also be a shorter recovery time and reduced risk of additional complications like blood loss that can be associated with any radical treatment. But, could this be at the cost of reduced cancer control? 

Potential advantages: reduced side effects

So far, results of recent focal therapy trials do look promising in terms of the side effects men experience, but we don’t yet know if they’re really any better than traditional whole-gland options. This is because so far, there haven’t been any trials of focal therapies or radical treatments that are set up to allow comparisons between the two.

Reducing side effects is a major driver for developing new cancer therapies, but it’s not enough on its own. Any new treatment still has to control the cancer effectively. So the big question is, how good is focal therapy at controlling localised prostate cancer?

Remaining questions: cancer control 

The only way to really answer this is to test it out, in clinical trials. Over the last few years, researchers have tested various different types of focal therapies, then monitored the men involved in the trials afterwards to see how they’re doing. Only the two best documented types of focal therapy – cryotherapy and HIFU – have been tested for long enough, and on enough patients, to have published medium term outcomes (this means monitoring patients for three to five years after treatment to see how they do). These results suggest that focal therapy can do a good job of keeping localised prostate cancer under control, at least in the medium term.

But is this good enough? Yet again, that’s a question we can’t answer. At the moment, our best definition of ‘good enough’ is ‘at least as good as radiotherapy or surgery’, and without trials that allow direct comparison between whole-gland and targeted treatment, we just can’t say whether that’s the case. 

Types of focal therapy