For quite some time, Dr. Gapin at Sarasota Prostate Care has been a proponent of focal therapy in certain patients with localized prostate cancer. A recent prospective study out of Belgium demonstrates the merits of such an approach.

Focal therapy involves treating just the part of the prostate that has cancer while preserving the normal, healthy part. This approach is similar to a lumpectomy for breast cancer. In women, preserving breast tissue is done for cosmetic reasons. In men, preserving prostate tissue is done for functional purposes.

Focal therapy can be done very precisely with High Intensity Focused Ultrasound, or HIFU, to treat areas of prostate with cancer while leaving the rest of the prostate intact. The main benefit of this approach is first and foremost to adequately treat the cancer, but also to limit the subsequent side effects related to treatment. With focal HIFU, men experience no pain and minimal effect on sexual function and urinary symptoms.

The recent prospective trial out of Brussels, Belgium by Velthoven, et al. was published in the March 2016 issue of Prostate Cancer and Prostatic Diseases. The study included 50 patients over 8 years who underwent hemiablation HIFU for unilateral low to intermediate grade prostate cancer. Hemiablation means that the half of the prostate with cancer was treated while leaving the other half untreated. The men were followed for a mean of 40 months. The 5-year cancer-specific survival was 100% and metastasis-free survival rate was 93%. During follow-up, 14/50 (28%) exhibited a PSA elevation per Phoenix criteria and underwent repeat biopsy. Of those patients, only 3 (6%) patients were found to have residual cancer in the treated lobe and were subsequently treated successfully with salvage radiation therapy. Only 6 of the men developed erectile dysfunction and 3 developed persistent urinary incontinence.

The key to a focal therapy approach is patient selection. Focal therapy is not appropriate for every man with prostate cancer. Good candidates for focal HIFU have low to intermediate grade prostate cancer localized to a specific area of the prostate. This is confirmed with a high quality multiparametric prostate MRI and MRI-guided targeted biopsy. Patients who undergo focal therapy need to followed closely postoperatively with periodic PSA testing as well as MRI and possible repeat biopsy to confirm the cancer has been completely eradicated.

 

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