What is focal therapy?

Focal therapy means removing the cancer, while leaving the rest of the organ intact. This is done to retain as much normal function as possible, and so attempt to reduce the side effects, and recovery times, associated with radical treatment options.

Focal therapy is already a routine procedure in many other organ systems. For example, a woman with localised breast cancer might have a lumpectomy, or even a partial mastectomy, rather than removing the whole breast. Other examples include bowel cancer, renal cancer and liver cancer. Yet the development of such targeted focal therapies for prostate cancer has lagged behind.

A major reason for this is the difficulty clinicians have had – until recently – in being certain about where in the prostate the cancer is located, and how significant it is.

For focal therapy to be considered as a potential treatment, it is crucial that the clinician can;

  1. Accurately pinpoint the location of the cancer within the prostate
  2. Be sure that it’s a cancer that needs treatment and
  3. Be confident that the cancer is still confined to the prostate and hasn’t started to spread outside.

The inability to do this outside of specialist centres and clinical trials using state of the art imaging technologies has hampered the development of this type of treatment.

However, the rise of multiparametric (mp)MRI is changing this picture. In 2017, the results of the PROMIS trial showed that a more detailed form of MRI scan, called multiparametric MRI, before a biopsy could accurately locate the cancer within the prostate. Not only this, but when the urologist uses the mpMRI data to target the biopsy to the suspicious part of the prostate, they can diagnose clinically significant prostate cancer much more accurately.

Since the release of the PROMIS results, we’ve been working to ensure that men across the UK have access to high quality mpMRI before biopsy, and were rewarded by seeing this included in draft NICE guidelines for prostate cancer treatment in England and Wales towards the end of 2018.

The potential for widespread availability of high quality mpMRI before biopsy across the UK is a much-needed boost for the further development of focal therapies. It means more medical centres will have the technology to spot cancer within the prostate, and target focal therapy to those areas. It makes it feasible to test focal therapy on a national scale. If it’s shown to be as or more effective than traditional whole-gland therapies, it could be made available across the UK, and not just in specialist centers.

What are the pros and cons?