Focal therapy for prostate cancer: what the latest results mean for patients

Dr Philip Camilleri, Clinical Director of Urology at GenesisCare UK, comments on behalf of the GenesisCare UK Urology Clinical Reference Group (CRG) on new research into focal therapy for prostate cancer and a subsequent letter discussing how the findings should be interpreted.

A recent UK study has reported outcomes for 3,477 men with prostate cancer that had not spread to other parts of the body. The men received focal therapy using either high-intensity focused ultrasound (HIFU), which uses focused ultrasound energy to kill cancer cells, or cryotherapy, which destroys cancer cells by freezing them.

Focal therapy is different from treatments that target the whole prostate. Instead, the aim is to treat the area containing the cancer while leaving as much of the surrounding prostate and healthy tissue untreated as possible.

For many men, this approach is attractive because sensitive structures involved in urinary and sexual function sit very close to the prostate, so treating a smaller area may reduce the chance of affecting them. The key question, however, is whether these potential reduction in side effects can be achieved while maintaining reliable long-term control of the cancer.

The study brought together patient data collected through the HEAT and ICE registries at 14 UK centres between 2004 and 2024. It reported that:

• 3,477 men were included, with 2,897 receiving HIFU and 580 receiving cryotherapy.

• The estimated risk of dying from prostate cancer within 10 years was 0.13%.

• The estimated proportion of men whose cancer had spread to another part of the body within 10 years was 3.3%.

• An estimated 14% received hormone therapy, also known as androgen deprivation therapy (ADT), within 10 years.

• The estimated proportion requiring further focal treatment was 33%, while 30% went on to receive a radical treatment, such as surgery or radiotherapy.

At first glance, some of these figures are reassuring. The difficulty is that the study does not yet give us the full 10-year picture for most of the men who took part in the study. Patients were followed for a median of 3.3 years, and only 173 men, around 5% of the men, had actually reached 10 years of follow-up. The 10-year figures are therefore estimates rather than outcomes that have been observed in most of the 3,477 men.

One of the main reasons someone might consider focal therapy is the possibility of reducing side effects.

The study didn’t report patients’ urinary function, sexual function or overall quality of life. This means that this study can’t tell us whether men treated with focal therapy experienced fewer of these side effects than men treated with surgery radiotherapy.

That does not mean focal therapy can’t offer benefits for some patients. It means that this particular study can’t answer that question. To understand the difference properly, future studies need to ask patients directly about their symptoms, sexual and urinary function and quality of life, and compare these results with other treatments.

Not necessarily. The study estimated that 33% of men would undergo another focal treatment within 10 years, while 30% would go on to receive a radical treatment such as surgery or radiotherapy, meaning that the treatment is only successful as a one-off treatment in a small proportion of cases.

For someone considering focal therapy, this is an important part of the conversation. A treatment that initially involves targeting only part of the prostate may still be followed later by another focal procedure or by treatment of the whole prostate. Each treatment can bring its own side effects and recovery, so the possibility of needing further treatment should be understood from the beginning. Early studies suggest that radiotherapy, including SABR, can still be used if the cancer returns after focal therapy, but we need more long-term evidence to understand how well these treatments work and what side effects patients may experience.

The GenesisCare UK Urology CRG supports continued research into focal therapy, particularly for carefully selected patients. These results add useful information, but they don’t show that focal therapy provides the same long-term cancer control as surgery or radiotherapy, or that it causes fewer side effects.

For men with localised prostate cancer who need radical treatment, surgery and radiotherapy remain established treatment options with a much larger body of long-term follow-up data. Focal therapy does not yet have the same level of evidence to support its routine use alongside these treatments.

For patients, the important thing is to understand not only what a treatment involves today, but what this may mean over the years that follow. The right treatment will depend on the type and extent of the cancer, a person’s overall health, the possible side effects and what matters most to them when weighing up the different options.