Focal Therapy

Focal therapy for prostate cancer is a treatment approach that targets only the cancerous area(s) within the prostate while leaving the rest of the gland intact. The goal is to control the cancer while reducing side effects such as urinary incontinence and erectile dysfunction that can occur with treatments of the entire prostate.

Who is it for?

Focal therapy is generally considered for carefully selected men with:

• Localized prostate cancer (confined to the prostate).
• Usually intermediate-risk disease, though some men with low-risk cancer may be better served by active surveillance.
• A clearly identifiable tumour on multiparametric MRI and targeted biopsy.
• No evidence that the cancer has spread outside the prostate.

It is not appropriate for everyone, particularly if the cancer is widespread throughout the prostate or has spread beyond it.

Types of focal therapy

Several techniques are used to destroy the tumour:

• High-Intensity Focused Ultrasound (HIFU): Uses focused ultrasound waves to heat and destroy cancer tissue.
• Cryotherapy: Freezes cancer cells using thin probes.
• Irreversible Electroporation (IRE, also called NanoKnife): Uses electrical pulses to damage cancer cell membranes.
• Laser ablation: Uses laser energy to heat and destroy tissue.
• Photodynamic therapy: Uses a light-activated drug and laser light to destroy cancer cells (less commonly used).

Potential advantages

Compared with whole-gland treatments such as radical prostatectomy or radiotherapy, focal therapy may:

• Preserve urinary continence in most men.
• Better preserve erectile function.
• Require a shorter recovery period.
• Be repeated if necessary.
• Leave other treatment options available if the cancer returns.

Limitations

Focal therapy also has important limitations:

• Long-term cancer control data are less mature than for surgery or radiotherapy.
• Prostate cancer is often multifocal (present in more than one area), so untreated cancer elsewhere in the prostate may remain.
• Careful follow-up is essential, including PSA testing, MRI scans, and sometimes repeat biopsies.
• Some men will eventually require additional focal treatment or definitive treatment with surgery or radiotherapy.

Possible side effects

Although generally less common than with whole-gland treatment, side effects can include:

• Temporary urinary symptoms (frequency, urgency, burning).
• Blood in the urine or semen.
• Urinary tract infection.
• Erectile dysfunction (less common than after surgery but still possible).
• Urinary retention requiring a temporary catheter.
• Rarely, injury to the rectum or urethra.

How effective is it?

Studies have shown promising results:

• Most men remain free of clinically significant cancer in the treated area for several years.
• Around 70–90% of carefully selected patients avoid radical treatment over the first 5 years, although results vary depending on the treatment method and patient characteristics.
• Long-term outcomes beyond 10 years are still being studied.

Current guideline recommendations

Many clinical guidelines consider focal therapy a reasonable option for selected patients, but they also note that evidence is still evolving. Some recommend it primarily within experienced centres or clinical trials, while others support its use after careful discussion of the uncertainties and the need for ongoing surveillance.

Is it right for you?

The decision depends on several factors, including:

• Your PSA level.
• MRI findings.
• Biopsy results (including the Grade Group/Gleason score).
• Whether the cancer is confined to one area.
• Your age, general health, and treatment priorities (for example, preserving urinary or sexual function).

If you’re considering focal therapy, it’s worth asking your urologist:

• Am I a suitable candidate for focal therapy?
• Which focal therapy technique do you recommend and why?
• What are the chances I’ll need further treatment?
• How will I be monitored afterwards?
• What are my expected urinary and sexual outcomes compared with surgery or radiotherapy?

Mr Raj Nigam explains what the treatment options are for prostate cancer

Mr. Raj Nigam (Consultant Urologist, The Focal Therapy Clinic): Prostate cancer is classified as localized, locally advanced, or advanced. Focal therapy is suitable for early localized cases, with treatment options including HIFU, cryotherapy, and NanoKnife. Choosing the right treatment depends on cancer stage and individual patient factors.

Focal Therapy Prostate Cancer: Concept & Benefits (Raj Nigam Webinar)

In this Focal Therapy Clinic webinar, Mr. Raj Nigam defines focal therapy as treating only the cancerous area of the prostate (like lumpectomy in breast cancer), preserving healthy tissue, nerves, urethra, and continence sphincter to dramatically reduce side effects while enabling same-day recovery. Unlike radical treatments, focal therapy involves no radiation, no hormones, can be repeated, and leaves all radical options available if needed (only 5-10% require whole-gland treatment with proper selection).

Is Focal Therapy the solution to Prostate Cancer?

Focal therapy is an emerging treatment option for early-stage prostate cancer, targeting only the cancerous areas while preserving healthy prostate tissue. Could this be a revolutionary alternative to traditional treatments? Find out how focal therapy works, its benefits, and whether it’s the right choice for you or a loved one.

Is focal therapy effective against prostate cancer?

Mr. Raj Nigam (Consultant Urologist) & Dr. Christos Mikropoulos (Consultant Oncologist) – The Focal Therapy Clinic: Focal therapy is as effective as radical prostatectomy at 8 years, with lower incontinence rates (less than 2%) and most men remaining disease-free while avoiding radical treatment. This minimally invasive approach offers excellent cancer control while preserving quality of life.

HIFU for prostate cancer: how does it work?

Mr. Tim Dudderidge (Consultant Urologist, The Focal Therapy Clinic): HIFU (High-Intensity Focused Ultrasound) uses focused ultrasound waves to heat and destroy prostate cancer cells, reaching 80°C at the target area. This effectively “cooks” the tumor while preserving surrounding healthy tissue, offering a minimally invasive treatment option for suitable patients.

Mr Raj Nigam: How does NanoKnife work?

Mr. Raj Nigam (Consultant Urologist, The Focal Therapy Clinic): NanoKnife is an advanced focal therapy technique that uses electrical pulses to destroy cancer cells while preserving surrounding structures, reducing side effects and maintaining quality of life. This minimally invasive treatment is an effective option for select prostate cancer patients.

What are the different types of focal therapy

Mr. Tim Dudderidge (Consultant Urologist, The Focal Therapy Clinic): Focal therapy can be delivered through three main energy sources—HIFU, cryotherapy, and NanoKnife. HIFU is the least invasive, making it ideal for posterior tumors, while needle-based therapies like cryotherapy and NanoKnife are better suited for anterior tumors. Understanding these options helps patients make informed treatment choices.

HIFU for prostate cancer: how does it work?

Mr. Tim Dudderidge (Consultant Urologist, The Focal Therapy Clinic): HIFU (High-Intensity Focused Ultrasound) uses focused ultrasound waves to heat and destroy prostate cancer cells, reaching 80°C at the target area. This effectively “cooks” the tumor while preserving surrounding healthy tissue, offering a minimally invasive treatment option for suitable patients.

Mr Tim Dudderidge: What happens during focal therapy

Mr. Tim Dudderidge (Consultant Urologist, The Focal Therapy Clinic): Focal therapy procedures last 60–90 minutes under anesthesia, using MRI-ultrasound fusion to precisely target cancer. HIFU, cryotherapy, and NanoKnife effectively destroy cancer cells while preserving healthy tissue, offering a minimally invasive alternative to surgery or radiotherapy.