Focal therapy is a treatment option for prostate cancer. It aims to remove the cancer from the prostate while preserving the rest of the gland.

Prostate cancer occurs when cells in the prostate gland grow in an irregular and excessive way.

Prostate cancer is the second most common type of cancer in males after skin cancer, according to the American Cancer Society. Medical professionals diagnose approximately 288,300 new cases of prostate cancer in the United States each year.

Focal therapy is a treatment option that aims to treat only the area of the prostate gland where the cancer is present. This treatment may take different forms, and a doctor can help advise on the best one for each individual.

This article outlines what focal therapy is, lists the types of focal therapy, and discusses the possible pros and cons of the treatment.

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Focal therapy is a treatment that removes the cancer from the prostate. It aims to treat only the area of the prostate where the cancer cells are present.

This is an alternative to other prostate cancer treatments that may treat the prostate as a whole.

Focal therapy allows healthcare professionals to treat cancers considered clinically significant (likely to spread and cause harm if not addressed) while reducing the damage they cause to the adjacent structures in the prostate.

Focal therapy can reduce adverse events and preserve the function of the prostate gland compared to treatments that target the whole prostate.

Forms of focal therapy include:

  • cryotherapy
  • high intensity focused ultrasound (HIFU)
  • irreversible electroporation (IRE)
  • photodynamic therapy (PDT)

The following sections explain the various types of focal therapy for prostate cancer. It is important to note that these therapies are alternative treatments for prostate cancer. Surveillance, surgery, and radiation therapy remain the standard treatments for this type of cancer.

Cryotherapy

Cryotherapy is one of the most common forms of focal therapy for prostate cancer.

During cryotherapy, a healthcare professional uses very cold temperatures to freeze cancer cells in the prostate.

They do this by guiding hollow needles through the skin between the anus and scrotum. They then pass the needles into the prostate and pass very cold gasses through the needles to freeze and destroy the cancer cells.

This is a less invasive procedure than surgery, which often means there is:

  • less blood loss
  • a shorter hospital stay
  • a shorter recovery period
  • less pain

Cryotherapy is generally a safe option for people with localized prostate cancer. “Localized” means the cancer is limited to the area where it began and has not spread to other areas of the body.

HIFU

HIFU is another common form of focal therapy for prostate cancer.

Ultrasound is a treatment that uses high frequency sound waves to go deep into human tissues and interact with these tissues.

HIFU is a procedure that allows a healthcare professional to deliver highly intense sound waves to the cancer cells in the prostate.

The energy that the healthcare professional delivers is enough to increase the temperature of the cancer tissue and kill the cells.

IRE

IRE is another common form of focal therapy for prostate cancer.

It uses electrical currents to destroy cancer cells.

During the IRE procedure a healthcare professional inserts needles into the prostate and places them on either side of the cancer cells.

They then use an IRE machine to pass an electrical current from one needle to the other through the cancer tissues. This electric current causes the membrane of the cancer cell to become unstable, which leads to irreversible damage.

PDT

PDT is another common form of focal therapy for prostate cancer.

PDT uses a medication called a photosensitizer or photosensitizing agent to kill cancer cells.

When someone exposes these medications to light, they produce a form of oxygen called an oxygen radical. It is the oxygen radical that kills the cancer cells.

During PDT, a person takes the photosensitizer. They may:

  • take it orally
  • have it spread on their skin
  • receive it intravenously (through an IV)

After 24–72 hours, most of the drug will have left the body’s healthy cells. However, the drug will remain in cancer cells.

During the procedure, a healthcare professional inserts a thin tube (an endoscope) into the prostate so they can guide the correct wavelength of light onto the cancer cells.

Once the light reaches the cancer cells, it triggers the photosensitizers to produce the oxygen radical.

The main benefit of focal therapy is to provide effective cancer treatment whilst having a low impact on the person’s quality of life.

The two main side effects associated with standard prostate cancer treatments are:

A 2021 systemic review investigated erectile function after focal therapy for prostate cancer. It concluded that overall, erectile function after focal therapy was generally good. Many studies featured in the review reported complete recovery of erectile function 1 year after the procedure.

A 2021 comparative study analyzed erectile function and urinary continence after both focal therapy and the more traditional whole gland ablation for prostate cancer.

The study concluded that focal therapy provided better results related to erectile function and urinary continence than whole gland therapy.

Yet focal therapy does have some possible side effects. These include:

  • Hematuria: Hematuria refers to the presence of blood in the urine. It is a common side effect of focal therapy for prostate cancer.
  • Urinary tract infection (UTI): A UTI occurs when bacteria enters the urethra and infects the urinary tract. People may experience a UTI after focal therapy for prostate cancer.
  • Acute urinary retention: Acute urinary retention causes someone to be unable to urinate even if they have a full bladder.
  • Numbness and swelling: Numbness and swelling in the penis and scrotum are less common than the other possible side effects.

Most of these possible side effects are mild and tend to occur during the first 30 days after treatment. A person can often manage these side effects using medication. They usually do not require any invasive procedures to manage their side effects.

Focal therapy is a treatment option for people with localized prostate cancer.

Localized cancer is cancer that remains in the place where it started and has not spread to other areas of the body.

One 2022 systemic review analyzed the survival rates of people after they received different forms of focal therapy.

For cryotherapy, around 87% of people experienced prostate cancer-specific survival after an average of 10 years post-treatment.

Studies show that for HIFU 100% of the people experienced prostate cancer-specific survival 7 years post-treatment, and the overall survival rate was 97%.

The systemic review showed that in a number of studies, people who underwent IRE experienced residual prostate cancer after treatment.

The review concluded that IRE may be an effective treatment for prostate cancer but stated that residual or positive biopsy rates still exist.

One 2017 study randomly assigned 206 patients with low risk prostate cancer to PDT or active surveillance. After 24 months, only 28% of the PDT group experienced disease progression, compared with 58% in the active surveillance group.

The study concluded that PDT is a potentially safe and effective treatment for low risk, localized prostate cancer.

Learn about other treatment methods for prostate cancer.

Focal therapy is a treatment for localized prostate cancer. It aims to remove the cancer from the prostate while reducing the damage to the adjacent structures in the prostate.

This means focal therapy can help avoid adverse side effects associated with other possible treatments, such as ED and UTIs.

The different types of focal therapy for prostate cancer include cryotherapy, HIFU, IRE, and PDT.

Possible side effects of focal therapy are minimal and include hematuria, UTIs, acute urinary retention, numbness, and swelling.

Individuals should discuss all treatment options with their healthcare professional.