Focal Therapies for Prostate Cancer

Focal therapy treats only the part of the prostate where cancer has been found. These treatments may have fewer side effects for some people, but they are not standard treatment for most patients. 

What is focal therapy?

Focal therapy is a type of prostate cancer treatment. It targets the area of the prostate where the cancer is known or believed to be.

The goal is to destroy the tumor while protecting as much healthy prostate tissue as possible.

Types of focal therapy may include:

• HIFU, or high-intensity focused ultrasound, which uses sound waves to heat and destroy tissue
• Cryotherapy, which freezes tissue to kill cancer cells
• Laser ablation, which uses laser heat to destroy tissue
• IRE, or irreversible electroporation, also called NanoKnife, which uses electrical pulses to damage cancer cells

You may also hear these treatments called partial-gland treatment or partial ablation. This means only part of the prostate is treated.

What do the guidelines say?

Leading medical groups, including the American Urological Association (AUA) and the National Comprehensive Cancer Network (NCCN), say focal therapy has a limited role in prostate cancer care.

For most people with newly diagnosed prostate cancer that has not spread:

• focal therapy is not standard treatment
• there is not enough long-term evidence to show it works as well as surgery or radiation
• it may be used only in limited situations
• it is often best considered as part of a clinical trial

A clinical trial is a research study that helps doctors learn if a treatment is safe and works well.

In some cases, focal therapy may be considered if prostate cancer comes back after radiation. This depends on your cancer, your overall health, and your care team’s experience.

Why is focal therapy not for everyone?

Focal therapy may sound simple, but there are important limits.

Cancer may be hidden

Prostate cancer can grow in more than one part of the prostate. Even if an MRI or biopsy finds one tumor, there may be cancer in other areas.

An MRI is an imaging test that helps doctors see inside the body. A biopsy is a test that removes small pieces of tissue to look for cancer.

Long-term results are still being studied

Doctors have many years of information about surgery and radiation. Focal therapy does not yet have the same long-term proof.

Follow-up is still needed

After focal therapy, you may still need:

• PSA blood tests
• MRI scans
• repeat biopsies
• more treatment later if cancer remains or comes back

Possible benefits and risks

Some patients choose focal therapy because it may:

• treat a smaller area
• lead to a faster recovery
• lower the risk of some urinary or sexual side effects

But focal therapy also has risks. It may miss cancer in other parts of the prostate. Some patients may need more treatment later, including surgery or radiation.

Experience matters

If you are thinking about focal therapy, ask if the doctor and treatment center have experience with prostate cancer and focal therapy.

Also ask:

• How do you decide if I am a good candidate?
• How do you check for cancer in other parts of the prostate?
• What follow-up will I need?
• Is this treatment part of a clinical trial?

Questions to ask your care team

Before choosing focal therapy, ask:

• Is focal therapy recommended for my type of prostate cancer?
• Do current AUA or NCCN guidelines support it for me?
• Is my cancer low-risk, intermediate-risk, or high-risk?
• Is this treatment being offered as part of a clinical trial?
• How much experience does this doctor or center have with focal therapy?
• How will we know if the treatment worked or if cancer is still there?
• What follow-up tests will I need, and how often?
• What are the chances I will need surgery, radiation, or another treatment later?