Evaluating the role of focal therapy in patients with localized prostate cancer

This article evaluated which patients can benefit the most from focal therapy (treatments that target only the prostate cancer instead of the entire prostate gland) for prostate cancer. In addition, this research evaluated the effect of this treatment on sexual and bladder function.

Treatment which preserves as much prostate tissue as possible is now being considered when the prostate cancer is diagnosed early. This type of treatment is called focal therapy. Focal treatments include internal radiotherapy or brachytherapy (the insertion of very small radioactive seed like directly into the cancer), external beam radiation therapy (an x-ray beam is targeted directly at the cancer) and high intensity focused ultrasound (high energy sound waves are used to heat and destroy the cancer). The aim of this type of treatment is to preserve as much tissue as possible, thus limiting the damage to the prostate gland and the surrounding tissues, such as the bladder, bowel and nerves which control sexual function. Therefore, patients are expected to have less adverse effects such as loss of bladder control (urinary incontinence), bowel or sexual problems. 

This research included 2350 participants who took part in 30 different clinical studies. All participants received focal treatment for prostate cancer. This was either the first treatment for patients with a low or intermediate grade cancer, although some men with higher grades were treated, or it was delivered as salvage therapy (a form of treatment given after previous treatments have failed). The outcomes of the participants were followed up until 11 years after treatment.

Results showed that in men who did not receive previous treatments for prostate cancer, bladder function was preserved in 95% to 100% of patients. Erectile function (the ability of a man to achieve and maintain an erection long enough to engage in sexual intercourse) varied from 54 to 100% of participants. Additionally, 83 to 100% of patients did not have any clinical signs of cancer. In patients who received focal therapy as salvage treatment after failure of previous treatments for prostate cancer, 87.2% to 100% did not have urinary incontinence. Erectile function in these patients varied from 29% to 40% and 92% of them had an absence of any clinical signs of cancer.

Overall, this article showed that, when used as an initial treatment with the aim of curing prostate cancer, focal therapy provided good results and allowed a good urinary and erectile function in patients with localized (confined) prostate cancer.

A limitation of this study is that the outcomes of focal therapy were not compared to those of more invasive treatments in similar patients. Therefore it is not clear whether this treatment is as reliable or more beneficial as other treatments, although it shows good outcomes as this article points out.

Ask your doctor if focal therapy is appropriate for your situation.