Mr Tim Dudderidge

Mr. Tim Dudderidge: During a **typical focal therapy procedure**, you will be **asleep under general anesthesia**, with your legs positioned in **lithotomy** to allow access to the **perineum**. ### **Imaging & Treatment Planning** - A **transrectal ultrasound probe** is placed in the rectum. - In **HIFU**, this is the **treatment probe**; in **cryotherapy and electroporation (NanoKnife)**, it is a **standard ultrasound probe**. - The **ultrasound images are linked to your MRI scan** to identify the lesion and ensure **precise targeting**. - The treatment is planned with a **margin around the lesion**, capturing all cancer cells, including any microscopic “tentacles” of disease. ### **Treatment Procedures** 1. **HIFU (High-Intensity Focused Ultrasound)** - Uses **overlapping treatment zones**, typically **three or four sessions**, where heat destroys the cancer cells. - A **urethral catheter** is placed at the end of the procedure. 2. **Cryotherapy & NanoKnife (Electroporation)** - Involve placing **needles into the prostate** at various locations. - **Cryotherapy freezes cancer cells**, while **NanoKnife uses electrical pulses** to destroy tissue. - **MRI-ultrasound fusion** ensures accurate targeting and a sufficient **treatment margin**. ### **Procedure Duration & Recovery** - The treatment typically lasts **60–90 minutes**. - A **catheter is placed at the end of the procedure** to aid recovery. Focal therapy is **highly precise**, ensuring **effective cancer control** while preserving **urinary and sexual function** as much as possible.

Mr. Tim Dudderidge: When managing **prostate cancer**, there are several treatment options depending on the patient's condition and preferences: 1. **Conservative options** - **Watchful waiting** – for **older men** where treatment may not be necessary. - **Active surveillance** – for **men who may need treatment in the future** but do not require immediate intervention. 2. **Whole-gland treatments** - **Surgery (radical prostatectomy)** – removal of the entire prostate. - **Radiotherapy** – can be delivered in two ways: - **External beam radiotherapy** – radiation from outside the body. - **Brachytherapy** – radiation sources placed inside the prostate. 3. **Focal therapy** (a modern approach) - This method **targets cancerous tissue only**, **ablating (destroying) the cancer** while **sparing the healthy prostate tissue**. Focal therapy provides a **minimally invasive alternative** that can preserve prostate function while effectively treating cancer.

Mr Tim Dudderidge: After radical treatment, such as prostate removal, the structures that support continence and erectile function can be damaged in various ways. The urethral sphincter may be partially removed, while the nerves responsible for erectile function may be stretched, heated, clipped, or removed as part of the procedure. As a result, both continence and erectile function are negatively affected. With focal therapy, the goal is to avoid such damage by minimizing tissue destruction. We focus only on removing the cancer and a small margin of surrounding tissue where cancer cells may reside, which cannot be seen on scans. By using precise image fusion technology to guide the treatment, we significantly reduce the risk of harming erectile and continence function. Erectile function is particularly sensitive to damage. While some men, especially those treated on only one side of the prostate, may still experience some decline, the deterioration is much less severe than with surgery and is often treatable.