Focal therapy has emerged as a less aggressive treatment option for localized prostate cancer, designed to reduce side effects associated with traditional approaches. The procedure uses various technologies including cryotherapy, laser ablation, and high-intensity focused ultrasound to destroy cancerous tissue visible on MRI scans. Treatments are typically delivered in single sessions and can sometimes be performed in an office setting, contributing to their appeal among patients seeking to avoid complications like incontinence and erectile dysfunction.
The medical community remains divided on focal therapy’s effectiveness compared to standard treatments. Proponents received support last month from a U.K. study demonstrating that 10 years after treatment, only 0.1% of patients treated with focal therapy had died of prostate cancer, with higher satisfaction rates and lower side effect levels compared to other treatments. However, many specialists want additional long-term data and randomized trials directly comparing focal therapies to standard care. The American Urological Association classifies focal therapy as experimental and recommends it only within studies and prospective registries, though it acknowledges it as an option for intermediate-risk cancer.
Current usage of focal therapy remains limited in the United States, with only 1.3% of prostate cancer patients receiving the treatment. Under AUA guidelines, approximately 10% to 20% of cases would qualify for focal therapy. Treatment preferences among focal therapy providers have shifted significantly, with cryotherapy declining from nearly 80% of procedures in 2010 to 20% by 2023, while laser ablation and high-intensity focused ultrasound have grown in popularity. Patients undergoing focal therapy report high satisfaction levels, though commercial insurance often does not cover the procedure, with costs around $17,000 out of pocket in some cases, despite Medicare coverage availability.
Following focal therapy, patients undergo monitoring through blood testing, MRI scans, and sometimes biopsies. If cancer appears in other areas of the prostate, additional focal therapy sessions may be appropriate, though recurrence in treated areas typically leads to radiation or surgery recommendations.
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