Focal therapy represents an alternative approach to treating localized prostate cancer that aims to preserve the gland while destroying cancerous lesions identified on MRI scans. Rather than removing or irradiating the entire prostate, as is standard practice for most patients, focal therapy uses various technologies including cryotherapy, laser ablation, and high-intensity focused ultrasound to target specific tumors. These procedures are often completed in single sessions lasting 40 minutes to a couple of hours and can sometimes be performed in an office setting, contributing to their appeal among patients seeking to minimize treatment burden.
The medical community remains divided on focal therapy’s merits. Providers offering the treatment cite a recent U.K. study indicating that 10 years after treatment, only 0.1% of patients had died of prostate cancer, with outcomes comparable to standard treatments while showing higher satisfaction rates and lower side effect levels. However, many specialists call for additional long-term data and evidence from randomized trials comparing focal therapies directly to conventional care. The American Urological Association maintains that focal therapy remains experimental, though it acknowledges it as an option for intermediate-risk cancer when performed as part of formal studies and prospective registries.
Surgical removal of the prostate typically causes initial incontinence in nearly all patients, with 5% to 10% experiencing permanent incontinence; more than half of men lose sexual function in the medium to long term. Radiation therapy requires several weeks of daily treatment and carries risks of temporary incontinence and erectile dysfunction. Focal therapy’s side effect profile is generally limited unless the lesion is located near sensitive anatomical structures, making it an attractive option for many patients despite concerns about incomplete gland treatment.
Currently, focal therapy uptake remains low in the United States, with recent data showing only 1.3% of prostate cancer patients receiving the treatment. The most popular methods have evolved over time, with laser ablation accounting for approximately 45% of procedures and high-intensity focused ultrasound representing the fastest-growing option at 35% in 2023. Patients receiving focal therapy undergo ongoing monitoring through blood tests, MRIs, and sometimes biopsies, with options for additional focal therapy sessions if cancer appears in untreated areas.
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