Focal Therapy for Prostate Cancer

For men in America, prostate cancer is the most common form of cancer. The prostate gland is found under the bladder and performs an essential role in the reproductive process. Although prostate cancer and other prostate issues are prevalent, signs of prostate cancer can often go undetected for significant periods of time. However, once prostate cancer is diagnosed, there are a multitude of treatments to choose from based on the severity of the patient’s case and other factors, such as age, family background and race.

Like most cancers, early diagnosis and treatment of prostate cancer dramatically increases success rates. As researchers determine and perfect new ways to identify prostate cancer in early stages, treatments are employed to slow, or possibly stop, the spread of cancer. One main course of action to treat prostate cancer is by utilizing focal therapies. The term focal therapy covers a wide range of noninvasive procedures which target prostate cancer tumors with little to no damage to the non-cancerous tissue surrounding them. This type of therapy is appealing because it limits the impact of treatment on a patient’s daily life and reduces recovery time. Although some of these therapies for treating prostate cancer are relatively new, with two of the main high-intensity focused ultrasound (HIFU) devices being approved by the FDA in 2015 for prostate tissue ablation, focal therapy has been successfully used in treating cancer in other locations of the body, including the brain and kidneys.

Because prostate cancer tends to grow slowly (tumors typically take approximately two to four years to double in size), many patients are diagnosed with localized, low-risk forms of prostate cancer. Since a lot of men are diagnosed early, extreme procedures like prostatectomy and radiation may be unnecessary and could potentially cause more harm than good with side effects such as urinary incontinence, erectile dysfunction and bowel toxicity. Focal therapies are focused on minimizing negative side effects while maximizing patient’s overall quality of life post-surgery. In patients with localized prostate cancer, focal therapies can be used to target the small areas of cancerous cells to eradicate the cancer completely. With patients who have more extreme cases of prostate cancer, focal therapies can help maintain control of the disease by reducing the size of the main cancerous tumor while a determination for further treatment is discussed and decided. Because focal therapies have a better ability to target the specific plagued region, other alternative treatments which may target a different area than the focal therapy can happen simultaneously, allowing focal therapies to be an advantageous addition to more advanced prostate cancer management.

There are various forms of focal therapies currently in use for prostate cancer, including HIFU, cryoablation and focal laser ablation. HIFU utilizes guided mechanical and thermal energy to destroy the infected and cancerous tissue in the prostate.

Focal Prostate Therapy
With Focal HIFU, only the tumor is targeted with heat. There as less side effects since less tissue is targeted.

Although HIFU patients have experienced side effects such as impotence and incontinence, most patients have minor complications as a result of treatment. As HIFU technologies advance, post-treatment problems continue to decline. In multiple studies of patients after HIFU usage, approximately 80 percent of patients remained cancer free after five years. As years pass after the surgery, they have a higher change of redeveloping prostate cancer. In another related study, of the 19 patients who underwent HIFU, 17 patients had low to no volumes of cancer when biopsied and were able to have intercourse and go about their daily life without significant changes in their urination.

Similar to HIFU, cryoablation directly targets the plagued area of prostate cancer. The main difference in these treatments is that while HIFU uses thermal energy, cryoablation utilizes extreme cold to damage and eradicate the cancerous regions. Cryoablation has evolved over time, so statistics vary on success rate, but a recent study from Cryo On-Line Data (COLD) showed three-quarters of patients remained cancer free three years after their treatment.The use of cryotherapy continues to increase as focal therapies become more popular.

Another focal therapy known as focal laser ablation has emerged in the last decade as an alternative to both cryoablation and HIFU. Focal laser ablation offers a deeper insight into the targeting, which can increase the overall success of the treatment while lowering the negative side effects. Laser ablation can be monitored with an MRI while the treatment is happening, so doctors can confirm they are hitting the infected regions with real-time monitoring without accidentally damaging uninfected parts of the prostate. Because focal laser ablation is relatively new, success rates are not as consistent or frequently found. However, as this treatment option becomes more popular, studies will begin to track the overall value of the surgery in eradicating cancerous regions and the frequency of prostate cancer recurrence in patients.

Due to the regular occurrence of prostate cancer in men, research is ongoing in order to better diagnose, maintain and treat this ailment. When diagnosed in the early stages, prostate cancer is oftentimes low risk, so treatment options like focal therapies which offer less risk and complications will continue to be used and perfected. Although they are new treatment options, focal therapies provide an excellent balance of effectiveness against early stages of the cancer while allowing patients to maintain a high quality of life without causing further complications, making these options an imperative alternative to radiation and prostatectomy.

Article: JU – Tissue Sparing (2011) – Focal Therapy for Localized Prostate Cancer: A Phase I/II Trial