Focal therapy for prostate cancer precisely targets and destroys cancerous tissue within the prostate. This approach aims to preserve surrounding healthy prostate tissue and nearby structures, serving as an alternative to traditional treatments that involve the entire prostate gland.
How Focal Therapy Works
Focal therapy operates on the principle of targeted ablation, precisely destroying only identified cancerous regions. This precision is achieved through advanced imaging techniques, such as multi-parametric MRI (mpMRI), which helps visualize and characterize tumors.
Following imaging, targeted biopsies are often performed to accurately map the exact location and extent of cancerous areas. This detailed mapping allows clinicians to deliver energy directly to the tumor, minimizing damage to healthy prostate tissue. The goal is to protect surrounding structures, including nerves responsible for erectile function and the urinary sphincter, which controls bladder function.
Different Types of Focal Therapy
Focal therapy employs various methods, each using a distinct energy source to eliminate malignant tissue while sparing healthy prostate. The choice of method depends on tumor characteristics and patient suitability.
High-Intensity Focused Ultrasound (HIFU) uses precisely focused sound waves to generate heat, destroying cancer cells through thermal effects and cavitation. A probe inserted into the rectum delivers these sound waves, heating and ablating small areas of the prostate. Cryotherapy, or cryoablation, destroys cancer cells by exposing them to extreme cold. Thin metal probes are inserted into the prostate, delivering a gas that freezes the tissue, creating ice balls through repeated freeze-thaw cycles.
Photodynamic Therapy (PDT) involves injecting a light-sensitive drug (photosensitizer) into the bloodstream. When a specific wavelength of light is applied to the prostate, it activates the drug, producing reactive oxygen species that kill cancer cells. Irreversible Electroporation (IRE), also known as NanoKnife, utilizes short, high-voltage electrical pulses delivered through needle-like electrodes. These pulses create permanent pores in the membranes of cancer cells, leading to their death without relying on heat or cold.
Who is a Candidate for Focal Therapy
Focal therapy is considered for patients with localized prostate cancer, meaning it is confined to the prostate gland. Patients with low-to-intermediate risk prostate cancer, often characterized by specific Gleason scores and PSA levels, are generally the most suitable candidates.
This treatment is also considered for unifocal disease, or multifocal disease where all significant tumors can be precisely identified and targeted. Patient preference for potentially fewer side effects also plays a significant role in determining suitability. While active surveillance may be appropriate for some low-risk cases, focal therapy offers a middle ground for those seeking intervention without whole-gland treatment.
Expected Outcomes and Quality of Life
Focal therapy offers advantages over whole-gland treatments, particularly for quality of life. A primary benefit is significantly reduced rates of side effects like erectile dysfunction and urinary incontinence. This reduction occurs because healthy prostate tissue and critical nerves are largely preserved.
While long-term data for cancer control are still developing compared to traditional treatments, focal therapy shows effectiveness in controlling localized prostate cancer. The possibility of cancer recurrence exists, as with any cancer treatment, but focal therapy allows for retreatment or other salvage therapies if needed. Patients often experience a faster recovery.
What to Expect During and After Treatment
Before undergoing focal therapy, patients typically have pre-treatment evaluations. The procedure is often performed on an outpatient basis or requires a short hospital stay, usually under general or regional anesthesia.
During the procedure, a device is inserted into the prostate to deliver energy that destroys the cancer cells. Immediately following, patients may experience temporary discomfort, swelling, or a need for a urinary catheter. Most patients can resume light activities within a week and return to normal daily routines within two weeks. Regular, long-term monitoring is a standard part of follow-up care, including PSA blood tests, repeat MRI scans, and potentially follow-up biopsies, to ensure cancer control and detect any recurrence.