Focal therapy treats an area of the prostate that contains cancer while leaving the rest of the gland intact, aiming to reduce the impact on urinary control and erectile function compared with treating the whole prostate. It is an emerging option only for carefully selected patients based on their PSA, imaging and biopsy results.
It is important to understand that focal therapy is a relatively newer approach with long term evidence still developing. Current Australian and international guidelines recommend that it should be offered within clinical trials or registries. Active surveillance, surgery (radical prostatectomy) and radiotherapy remain the standard options, and every man who chooses focal therapy is currently committing to ongoing monitoring with PSA tests, imaging and repeat biopsy, with further treatment sometimes needed.
TREATMENTS
Focal Therapy for Prostate Cancer
When Is Focal Therapy Considered?
Focal therapy is not suitable for all prostate cancers. After detailed review of your MRI, PSA and biopsy results, usually including discussion at a multidisciplinary meeting, it may be considered when:
• The cancer is localised to the prostate and visible on MRI with biopsy findings that match
• There is a single dominant tumour, or disease confined to one region of the gland, that can be treated with a safety margin
• You understand and accept ongoing monitoring (PSA, imaging and follow-up biopsy) and the possibility of further treatment if cancer persists or returns
Focal Therapy Technologies
Several energy sources can be used to ablate the target area. The choice depends on where the tumour sits within the prostate, the size of the gland and your individual circumstances:
• NanoKnife (irreversible electroporation, IRE): fine needle electrodes are positioned around the tumour under ultrasound guidance and short electrical pulses destroy the tissue within the targeted area of the prostate.
• ProFocal (laser focal therapy): laser ablation system that cools the laser fibre and monitors tissue temperature in real time, with early clinical trial results published and longer-term follow-up still under way
• HIFU (high-intensity focused ultrasound): a probe in the rectum focuses ultrasound waves to heat and destroy the target area, and is generally best suited to tumours towards the back of the gland
• Focal cryotherapy: freezing needles placed through the skin of the perineum destroy the tumour, and can suit tumours towards the front of the gland
No focal technology has been proven superior to the others, and none yet has the longer-term track record of surgery or radiotherapy. We can explain which options may be appropriate and available for you and be clear about what the current evidence does and does not show.
Risks and Considerations
All procedures carry risks, which your surgeon will discuss with you in detail. These may include:
• Cancer may persist in, or return to, the treated or untreated parts of the prostate, and some men later need repeat focal treatment, surgery or radiotherapy
• Urinary infection, blood in the urine or semen, and temporary difficulty passing urine, sometimes needing a catheter for a few days
• Erectile difficulties or reduced ejaculate, usually less frequent than after whole-gland treatment but still possible
• Rare injury to the urethra or rectum, including a fistula (an abnormal connection between the rectum and urinary tract)
• Long-term evidence is still developing, so ongoing PSA, MRI and biopsy surveillance is essential, and later surgery after ablation can be more complex
Recovery at a glance: Usually day surgery or one night in hospital, often with a catheter for a few days; most men are back to light work within a week, then follow a structured schedule of PSA tests, MRI and repeat biopsy.
1
Careful Selection
Your MRI, PSA and targeted biopsy results are reviewed, usually at a multidisciplinary meeting, to confirm the cancer is suitable and to talk through all alternatives, including active surveillance, surgery and radiotherapy.
2
The Ablation Procedure
Under general anaesthesia, the chosen energy source is guided to the tumour using ultrasound and MRI fusion, and the target area is destroyed with a safety margin.
3
Early Recovery
Most men go home the same or next day; if a catheter is used it is removed after a few days, and mild urinary symptoms usually settle over the following weeks.
4
Lifelong Monitoring
PSA testing, follow-up MRI and a scheduled repeat biopsy check the treated area; if significant cancer persists or returns, we discuss further focal treatment, surgery or radiotherapy.
Our Approach
