Research from a decade-long study led by Imperial College London suggests focal therapy offers an effective alternative to traditional prostate cancer treatments with reduced risks of adverse effects. The therapy uses high-intensity ultrasound or cryotherapy to target cancerous tissue within the prostate, and the study tracked nearly 3,500 men receiving the treatment.
The research, which medical regulators previously indicated lacked sufficient long-term data, showed that men with intermediate or high-risk prostate cancer experienced cancer control outcomes comparable to those achieved through surgery or radiation therapy. Among study participants, only two men died from the disease over the 10-year follow-up period. However, patients undergoing focal therapy experienced side effects at less than half the rate of those receiving conventional treatments, with particular reductions in complications such as urinary incontinence and erectile dysfunction.
Despite its introduction more than 20 years ago, focal therapy remains underutilized in the UK healthcare system. Approximately 1,000 men annually receive the treatment, despite estimates suggesting up to 15,000 patients could potentially benefit. Current NHS provision is limited to 10 centers in England, with none available elsewhere in the UK. The therapy is inappropriate for patients with cancer present in multiple prostate regions or disease that has extended beyond the gland itself.
A significant barrier to broader adoption has been the lack of long-term survival data and concerns about cancer recurrence rates when only part of the prostate is treated. This study challenges those concerns, having been supported by the National Institute for Health and Care Research. The National Institute for Health and Care Excellence has not approved focal therapy as routine treatment, primarily citing previously limited evidence, which has prevented hospitals from being required to offer it routinely.
The government committed up to £2.8m last month to expand focal therapy centers in England. Prostate cancer advocacy organizations have called for regulatory review of the new evidence, noting that reduced treatment side effects could facilitate development of a national screening program. A £60m trial called “Transform” is currently evaluating targeted screening approaches by combining rapid MRI imaging with lower-harm treatments including focal therapy when appropriate for diagnosed patients.