Are focal therapies an option for recurrent cancer?

This review examined the safety and effectiveness of focal therapies for recurrent localized prostate cancer. The authors concluded that there is early evidence to suggest that focal therapies are well-tolerated and effective for recurrent localized prostate cancer.

Radiation therapy is a common treatment for localized prostate cancer (cancer confined to the prostate gland). Some men are at increased risk of cancer recurrence after radiation therapy. Hormone therapy is often recommended in cases of cancer recurrence. Local therapies targeting the whole prostate gland are also commonly used as secondary treatments.

Both approaches, however, are associated with significant side effects. Recent studies have suggested that more focal therapies may reduce side effects. Focal therapies are directed only at the area containing the recurrent tumor. This is in contrast to targeting the whole prostate gland. Some focal techniques include cryotherapy (cold fluid to kill cancer cells), brachytherapy (radiation source placed inside the prostate), and high-intensity focused ultrasound (heat energy to kill cancer cells). The benefits of focal therapies for recurrent localized prostate cancer are still under exam.

This review included 8 separate trials, involving a combined total of 278 men. All men had recurrent cancer, confined to the prostate, after initial radiation therapy. Patients received treatment with focal techniques outlined above.

Blood tests revealed effective cancer control following focal therapies. One year after treatment, 69 to 100% of men did not show signs of cancer. After the second year, 49 to 100% of men showed no signs of cancer recurrence. At 5 years, about half (46.5 to 54.5% of men) were still cancer-free.

One trial directly compared focal to whole-prostate cryotherapy. 5 years after treatment, 54.4% of men undergoing focal cryotherapy were cancer-free. The rate of cancer recurrence was lower among men receiving whole-prostate cryotherapy (86.5% of men were cancer-free). Focal cryotherapy was associated with fewer side effects.

Side effects related to urinary, gastrointestinal, and sexual function were observed in 0 to 33.3% of men undergoing focal therapy. Most men retained their ability to achieve erection after focal therapy.

Authors concluded that focal therapies are a safe and effective alternative treatment option for recurrent localized prostate cancer. However, more high-quality evidence is needed to determine their overall benefit over standard therapies.

Larger clinical trials that randomize treatment allocations are needed to confirm these results.