At the moment, focal therapy – usually HIFU or Cryotherapy – is only available in specialist centres in the UK or as part of a clinical trial. So what needs to happen before focal therapy could be considered as a standard treatment option for localised prostate cancer?
The first thing is likely to be clinical trials that directly compare focal therapies to whole gland treatments. But this may not be as easy as it seems. For a trial like this to work, men will need to be randomly assigned to one type of treatment or the other; they won’t get to choose which treatment they get. So any men who particularly want to have focal therapy may not want to take part in a trial like this, and doctors with expertise in one technique or the other may find it difficult to counsel men without unintentional bias. This means it may be difficult to get as many men to participate as necessary. Luckily, Professor Hash Ahmed has come up with a solution to this, and we’re funding him to test this out. If successful, the team will seek funding to run a larger trial that will aim to confirm that focal therapy is an effective treatment for prostate cancer, and causes fewer side effects than standard treatments.
The second issue that remains unresolved, and can’t be sped up, is time. Doctors and health providers need to decide how long men must be followed up for after focal therapy trials to determine that treatments like are safe. Are the medium term, three to five year, follow ups enough? Or do we need longer term ten year follow ups to really be sure focal therapy is effective?
The final hurdle will be training for urologists. To take part in a recent focal therapy clinical trial, all the surgeons involved went through a rigorous training process. This involved online learning, observing a number of cases on different days in specialist centres, followed by a period of mentoring by focal therapy experts in their own hospitals. This is essential to make sure that any new surgical procedure is carried out to the high standards men deserve, but it will be no mean feat to deliver on a national scale.
Overall, the outlook for focal therapy is good. There’s still work to be done, but as we can really start to see a clear pathway to diagnosing prostate cancer earlier and more accurately, this is the moment for focal therapies to shine.