Can Focal Therapy Treat Prostate Cancer as Effectively as Surgery?

Focal therapy treats prostate cancer as effectively as surgery with fewer lasting side effects.

A less invasive treatment for localized prostate cancer offers cancer control comparable to surgery and radiotherapy while causing significantly fewer long-term side effects, according to one of the largest and longest follow-up studies of its kind. ()

The findings, published in the journal European Urology, suggest that focal therapy, which targets only the cancerous portion of the prostate instead of removing or treating the entire gland, could become an option for thousands more men if access to the treatment expands.

Researchers say the results may influence future treatment guidelines and increase the availability of focal therapy, which is currently offered only at a limited number of specialist centers in England.

What Is Focal Therapy?

Unlike conventional treatments such as radical prostatectomy or whole-gland radiotherapy, focal therapy destroys only the area of the prostate containing the most significant cancer while preserving as much healthy tissue as possible.

Because the treatment is highly targeted, it aims to reduce damage to nearby nerves and structures responsible for urinary control and sexual function.

Focal therapy can be delivered using several techniques, including high-intensity focused ultrasound (HIFU), cryotherapy, which freezes and destroys cancer cells, and irreversible electroporation (Nanoknife), which uses electrical pulses to kill tumor cells.

Large Study Finds Low Risk of Prostate Cancer Progression

Researchers from Imperial College London followed 3,477 men who underwent focal therapy for localized prostate cancer and assessed their outcomes over a period of 10 years. The results showed that only two men died from prostate cancer during the follow-up period, while about 3% experienced cancer spreading beyond the prostate.

These outcomes are comparable to those reported with surgery and radiotherapy, which are currently considered the standard treatments for localized prostate cancer.

Dr. Alexander Light, a urology registrar and doctoral fellow at Imperial College London, said the findings demonstrate that focal therapy can provide durable cancer control. “The results of our study are really encouraging,” he said, adding that many patients had benefited, “including men with more aggressive disease who would traditionally have been told focal therapy wasn’t an option for them.”

Focal Therapy Preserves Quality of Life

One of the biggest advantages of focal therapy is its lower risk of treatment-related complications. Standard treatments for prostate cancer, particularly complete removal of the prostate, can lead to lifelong urinary incontinence and erectile dysfunction, significantly affecting quality of life.

The study found that focal therapy carries a five-fold lower risk of these side effects because it preserves much of the healthy prostate and surrounding tissues. Researchers say this could make focal therapy especially attractive for men whose cancer is confined to a specific area of the prostate.

Thousands More Men Could Benefit From Focal Therapy

The researchers estimate that 50% to 66% of men with localized prostate cancer—around 15,000 patients each year in the UK—could be suitable candidates for focal therapy. Despite this, only about 1,000 men annually currently receive the treatment because it is available at only a handful of specialist NHS centers, most of them located in London and southeast England.

Joint senior author Professor Hashim Ahmed said the evidence supports wider adoption of the treatment. “Right now, only about 1,000 men per year have the treatment, when up to 15,000 men could—and are either not told about it, or do not have local access,” he said.

Could Focal Therapy Guidelines Change?

Researchers hope the new evidence will encourage the UK’s National Institute for Health and Care Excellence (NICE) to expand its recommendations for focal therapy, making it more widely available through the NHS.

The findings come as prostate cancer continues to place a substantial burden on healthcare systems. It is the most common cancer among men in the UK, with approximately 64,000 new cases diagnosed each year and more than 12,000 deaths annually.

The study also arrives amid ongoing debate over prostate cancer screening. Earlier this year, UK health officials decided not to introduce a nationwide screening programme after advisers concluded that routine testing could lead to overdiagnosis and unnecessary treatment, a decision that drew criticism from patient advocates.

What the Findings Mean for Prostate Cancer Patients

The researchers stress that focal therapy is not suitable for every patient. The treatment is intended for men whose cancer remains localized within the prostate and who meet specific clinical criteria based on imaging and biopsy findings.

However, for eligible patients, the new study suggests focal therapy may offer the best of both worlds—long-term cancer control comparable to surgery or radiotherapy, combined with a substantially lower risk of complications that can affect urinary function and sexual health.

The researchers say the results strengthen the case for making focal therapy more widely available, potentially giving thousands of men access to an effective treatment that preserves quality of life without compromising cancer outcomes.

References:

1. Oncological Outcomes Following Focal HIFU and Cryotherapy for Treatment of Nonmetastatic Prostate Cancer in the United Kingdom: An Updated Analysis of 3477 Patients from the Prospective HEAT and ICE Registries – (https://www.europeanurology.com/article/S0302-2838%2826%2902169-X/fulltext?utm_source=chatgpt.com)

Source-Medindia