TL;DR
- Top 10 UK specialist now “more positive than ever” about focal therapy after treating large patient cohort (Source: Daily Mail National Poll)
- High-quality MRI transforms screening rationale by enabling precise treatment with minimal side effects
- Patient enthusiasm for focal therapy exceeds expectations with many preferring targeted treatment over radical approaches
- Combination of early detection plus low-morbidity treatment creates compelling case for proactive prostate cancer screening
Reading Time: 10 minutes
Medically Approved by Mr Alan Doherty, Clinical Director (June 2025)
Expert Credentials: Voted Top 10 UK Prostate Cancer Specialist (Daily Mail National Poll)
Mr Alan Doherty is Clinical Director at Birmingham Prostate Clinic and recently voted one of the UK’s top ten prostate cancer specialists in a national poll of consultant urologists. He joined The Focal Therapy Clinic to develop his expertise in delivering focal therapy and has become increasingly optimistic about precision treatments for localised prostate cancer.
Key Insights from the Discussion
- Enhanced Expert Confidence: After treating a large cohort with focal therapy following rigorous MDT review, leading specialist reports increased optimism about treatment outcomes and patient suitability. + Jump to: Expert Views
- Unexpected Patient Demand: Patient enthusiasm for focal therapy exceeds clinical expectations, with many actively seeking targeted treatment even when not optimal candidates. + Jump to: Patient Demand
- Screening Revolution: High-quality MRI plus focal therapy creates first compelling rationale for prostate cancer screening by enabling early treatment without significant side effects. + Jump to: Screening Logic
- Quality-Driven Outcomes: Rigorous assessment protocols and multidisciplinary approach produce superior results compared to heterogeneous treatment approaches. + Jump to: Quality Impact
Expert Optimism: Why Views Have Changed
Mr Alan Doherty’s optimism about focal therapy has grown significantly after treating a large patient cohort. His experience demonstrates how clinical outcomes can shift expert perspectives when supported by rigorous assessment protocols.
“Having now treated a large cohort of patients with focal therapy following the clinic’s rigorous MDT review, I’m even more positive now about the approach than I’ve ever been.”
The transformation reflects improved patient selection through comprehensive multidisciplinary team review. High-quality MRI assessment enables confident treatment recommendations based on accurate cancer characterisation.
Expert optimism stems from observing patient outcomes in real clinical practice. The combination of precise diagnostics and targeted treatment produces results that exceed traditional expectations for cancer therapy.
| Previous Perspective | Current Optimism |
|---|---|
| Theoretical benefits of focal therapy | Proven outcomes in large patient cohort |
| Uncertain patient selection criteria | Confident assessment through rigorous MDT review |
| Limited experience with focal approaches | Extensive clinical practice with consistent results |
| Cautious about treatment promises | Increased confidence in patient benefit |
Surprising Patient Enthusiasm for Focal Therapy
Patient demand for focal therapy consistently exceeds clinical expectations. Many patients actively seek targeted treatment approaches even when other options might be technically more suitable.
This enthusiasm creates complex clinical scenarios. Patients research treatment options extensively and arrive with strong preferences for minimal-intervention approaches. Balancing patient preferences with clinical recommendations requires careful communication.
The preference for focal therapy reflects patient priorities around quality of life preservation. Men increasingly prioritise maintaining function while achieving cancer control rather than accepting side effects from radical treatments.
Quality of Life Focus
Patients prioritise maintaining sexual and urinary function alongside cancer treatment effectiveness.
Treatment Research
Men actively research options and arrive at consultations with informed preferences for targeted approaches.
Lifestyle Priorities
Active patients seek treatments that enable rapid return to normal activities and responsibilities.
Risk Tolerance
Many patients prefer accepting monitored small lesions rather than radical treatment side effects.
Patient enthusiasm extends to accepting partial treatment with monitoring. Many are comfortable treating main lesions while monitoring smaller areas, demonstrating confidence in ongoing surveillance capabilities.
How Focal Therapy Transforms Screening Logic
Focal therapy revolutionises the fundamental rationale for prostate cancer screening. The combination of early detection with low-morbidity treatment addresses traditional screening dilemmas.
“It virtually transforms the reasons why screening for prostate cancer is a good idea… if you have a treatment with very low side effect profile, which can be delivered accurately, it really does give a strong rationale for screening.”
Traditional screening concerns centre on overtreatment risks. Finding early cancers becomes problematic when available treatments cause significant side effects. Focal therapy eliminates this dilemma by enabling treatment without major morbidity.
High-quality MRI scanning forms the foundation of this transformation. Accurate imaging enables confident lesion identification and treatment planning while avoiding unnecessary biopsies for normal scans.
🎥 Watch: Mr Doherty Explains MRI-Guided Treatment Selection
Understanding how high-quality MRI scanning enables precise focal therapy planning and transforms the entire approach to prostate cancer diagnosis and treatment.
| Traditional Screening Concerns | Focal Therapy Solution |
|---|---|
| Overtreatment with significant side effects | Targeted treatment with minimal morbidity |
| Uncertain benefit-to-harm ratio | Clear benefit with low harm profile |
| Fear of unnecessary radical treatment | Confidence in proportionate intervention |
| Patient anxiety about screening consequences | Reassurance about treatment options available |
The screening transformation extends to diagnostic pathways. High-quality MRI assessment reduces unnecessary biopsies while improving cancer detection accuracy. Normal MRI scans avoid biopsy procedures entirely.
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Quality Assessment and Improved Outcomes
Rigorous quality standards produce superior focal therapy outcomes. The multidisciplinary approach ensures optimal patient selection and treatment delivery compared to less structured approaches.
Multidisciplinary team assessment provides comprehensive evaluation beyond individual clinician judgment. Collaborative review improves decision-making through diverse expertise and experience sharing.
High-quality MRI interpretation requires specialist radiologist expertise. Live scan review during MDT sessions enables comprehensive lesion assessment and treatment planning optimisation.
Quality-driven approaches produce better outcomes than heterogeneous treatment delivery. When focal therapy is performed properly with rigorous protocols, results exceed those achieved through varied approaches.
Evidence from diverse study populations understates potential outcomes. When studies show benefit across varied practitioners and protocols, dedicated centres with optimal approaches achieve even better results.
Future Adoption and Mainstream Integration
Focal therapy adoption depends on MRI quality development across healthcare systems. The natural progression from high-quality imaging to targeted treatment will drive mainstream integration.
MRI technology advancement creates foundation for focal therapy expansion. As imaging quality improves and becomes more accessible, targeted treatment approaches become feasible across broader healthcare settings.
Clinical integration requires comprehensive treatment portfolios. Effective focal therapy practitioners typically offer multiple treatment modalities, enabling optimal patient matching with appropriate approaches.
Patient education remains crucial for adoption success. Understanding MRI significance and treatment implications enables informed decision-making and appropriate treatment selection.
Technology Access
Expanding high-quality MRI availability creates foundation for focal therapy growth across healthcare systems.
Specialist Training
Developing expertise in multiple treatment approaches enables optimal patient matching and outcome optimisation.
Patient Education
Informed patients make better treatment decisions when they understand imaging and treatment significance.
Evidence Building
Accumulating clinical evidence supports mainstream adoption and healthcare system integration.
Questions for Your Consultation
Print and bring to appointments:
- MRI Quality Assessment: “What is the quality of MRI scanning available, and how does this affect my treatment options?”
- Focal Therapy Suitability: “Am I a candidate for focal therapy, and what factors determine this suitability?”
- Treatment Portfolio: “What treatment options do you offer, and how do you decide which is most appropriate for me?”
- Experience Level: “How many focal therapy procedures have you performed, and what are your outcomes?”
- MDT Review Process: “Will my case be reviewed by a multidisciplinary team before treatment recommendations?”
- Side Effect Comparison: “How do side effects of focal therapy compare to radical treatments for my specific case?”
- Long-term Monitoring: “What follow-up and monitoring will be provided after focal therapy treatment?”
- Quality of Life Impact: “How will focal therapy affect my daily activities and functional capabilities?”
About Mr Alan Doherty, Clinical Director
Mr Alan Doherty is Clinical Director at Birmingham Prostate Clinic and was recently voted one of the UK’s top ten prostate cancer specialists in a national poll of consultant urologists published in the Daily Mail. He has been an innovator, advocate and dedicated practitioner of precision treatments for prostate cancer. After joining The Focal Therapy Clinic to develop his expertise in delivering focal therapy and treating a large cohort of patients following rigorous MDT review, he has become increasingly optimistic about the future of focal therapy and outcomes for men diagnosed with localised prostate cancer.
Frequently Asked Questions
After treating a large cohort of patients with focal therapy following rigorous multidisciplinary team review, Mr Alan Doherty reports increased confidence in patient outcomes and treatment effectiveness. The combination of proper patient selection, high-quality MRI assessment, and careful treatment delivery has exceeded his initial expectations for focal therapy results.
Focal therapy transforms screening logic by enabling early cancer treatment without significant side effects. Traditional screening concerns centre on overtreatment risks, but focal therapy eliminates this dilemma by providing effective treatment with minimal morbidity. This creates the first compelling case for proactive prostate cancer screening.
Patient enthusiasm exceeds clinical expectations because focal therapy aligns with quality of life priorities. Men increasingly prefer maintaining sexual and urinary function while achieving cancer control. Many patients research options extensively and arrive with strong preferences for targeted approaches over radical treatments with significant side effects.
High-quality MRI scanning forms the foundation of successful focal therapy. Accurate imaging enables confident lesion identification, proper patient selection, and precise treatment planning. Quality MRI assessment also reduces unnecessary biopsies by avoiding procedures when scans are normal, improving the entire diagnostic pathway.
MDT review provides comprehensive evaluation beyond individual clinician judgment, improving decision-making through diverse expertise. Live MRI scan review during team sessions enables thorough lesion assessment and optimal treatment planning. This collaborative approach produces superior patient selection and treatment recommendations compared to individual assessment.
Men can be optimistic because early detection now leads to targeted treatment without major side effects. High-quality MRI enables accurate cancer identification while avoiding unnecessary biopsies for normal scans. When cancer is found early, focal therapy can treat it effectively while preserving quality of life, creating a compelling reason for proactive screening.
Clare Delmar
Hello and welcome to On Focus, brought to you by the Focal Therapy Clinic, where we connect you with issues facing men diagnosed with prostate cancer that are little known, less understood, often avoided or even ignored. Prostate cancer is the most commonly diagnosed cancer among men in the UK. And with this sombre fact comes a multitude of challenges and opportunities. I’m Clare Delmar. Joining me today is Alan Doherty, Clinical Director at the Birmingham Prostate Clinic and recently voted one of the UK’s top ten prostate cancer specialists in the national poll of consultant urologists published in the Daily Mail. Alan has been an innovator, advocate and dedicated practitioner of precision treatments for prostate cancer and he joined The Focal Therapy Clinic last year to develop his expertise in delivering focal therapy. Having now treated a large cohort of patients with focal therapy following the clinic’s rigorous MDT review, he’s even more positive now about the approach than he’s ever been and he joins me today to discuss how this experience makes him optimistic about the future of focal therapy and most importantly, the future for men diagnosed with localised prostate cancer. Alan, thank you so much for joining me today.
Alan Doherty
Hello, Clare, thank you for inviting me.
Clare Delmar
And I’m always impressed whenever we chat how positive you are, which is why I thought this would be a great theme to sort of set the stage. We’re halfway through the year. It’d be really good way to get you talking about what you’ve observed from treating your patients. And I guess the first thing I want to ask you is what kind of cases have you seen, well, certainly in the last year since you’ve joined the clinic and even more recently, that gives you cause for optimism?
Alan Doherty
I suppose I’d answer that by saying I’ve been surprised by the enthusiasm of so many patients to have focal therapy and some, of course, are more suitable for it than others. And in a way, how often patients, even if you don’t think they’re particularly suited for focal HIFU, they often still want it. So it’s a difficult balancing act from our end to offer treatments which we think are perfect for them versus patients who have a strong view as to what they want and not necessarily listening to us as clinicians. I can understand why, because they’re getting so many different opinions from everywhere. So that’s the first thing I’d say. I think the second thing I’d say is that I’ve been so impressed by the way The Focal Therapy Clinic are able to assess a patient so that when we are recommending a focal therapy, you can really have confidence that this is the right thing to do. And the reason I say that is because a lot of focal therapy…and management of prostate cancer in general… early prostate cancer… Is very much dominated by good quality MRI scanning. Within our group we’re able to do that so well and that gives me confidence that when I recommend focal therapy that this is the right thing for me to be doing for a patient.
Clare Delmar
It’s interesting you say about the clinic bringing you patients that are so enthusiastic and I think that has to do with our approach to what we call patient advocacy, the first port of call for many patients is our wonderful patient advocacy team, so they actually begin to understand each prospective patient’s kind of hopes and dreams, as it were, and what their lifestyles are like. So I think that adds into the mix. But of course, the other thing, when you reference MRI is, we do an extremely rigorous MDT. How do you think that MDT has impacted your views on the future of focal therapy?
Alan Doherty
Again, probably two aspects. One is I share ideas with my clinical colleagues who are treating prostate cancer day in, day out and it’s always good to share an idea, to have it critically assessed. And then the second thing is the way that we can look at an MRI scan in a live setting and everyone sort of picks up slightly different things about the MRI scan and what it all means. And I think out of all the MDTs that I do, and you can imagine we do a lot of MDTs, this particular one is the most influential. It’s the one where I learn the most and it’s the one that I really don’t want to miss because it’s the one which I give feedback to patients with better information than I can from just myself thinking about the case.
Clare Delmar
And do you think that the quality is continually improving as well so that you can really deliver optimal care for your patients?
Alan Doherty
Most definitely. I think there’s something that I’d like to say about the focal therapy. What I’ve learnt about it in the last year. Is that it virtually transforms the reasons why for screening for prostate cancer is a good idea. In other words, if you’re going to find a cancer early, you have to have a treatment that is effective but also doesn’t cause many side effects. And it’s this concept of overtreatment which is inherent in the screening of any condition, because if you pick something up early, you don’t know whether it’s going to be a problem in the future. But if the treatments you’re offering for early treatments are associated with a lot of side effects, then the arguments for a screening programme don’t really stack up. But if you have a treatment with very low side effect profile, which can be delivered accurately like we can in our focal therapy clinic, it really does give a strong rationale for screening. And that’s the first time I think I’ve ever been able to stand up in front of a lot of doctors and say, well, I think it makes sense to find this early because we can treat it even if it doesn’t turn into a problem in the future without many side effects. So why wouldn’t you do that? The more you understand about how we’re treating these cases, the more you can see why there’s benefit and very little harm.
Clare Delmar
And of course, a lot of that is driven by the evidence base that’s continually being generated. I mean, even this year there have been a couple of studies that have been published about men undergoing focal therapy that have been really positive. Do you think those, given what you just said, will drive its adoption and availability more widely?
Alan Doherty
Most definitely. I think one of the troubles with any treatment is you’ve got to, I suppose, compare apples with apples and oranges with oranges. Because when you do something properly, as I think we are in the focal therapy clinic, because we’re doing it in this multidisciplinary meeting and we’re doing it with very high quality MRI scans. Our results are going to be a lot better than if you just do it in a sort of happy go lucky type of approach. So I think if a study is showing benefit when it’s not just done by one dedicated group, but it’s done by a whole heterogeneic group of people, you’ve got to say that the likely outcomes are even better than the studies are showing.
Clare Delmar
That’s an interesting way to look at it.
Alan Doherty
Yeah. And I think the other thing to realise, again, something else I’ve noticed in my last year is that often patients will be prepared to have the main lesion treated with focal therapy and just monitor a smaller lesion on the other side. Now, that’s an interesting situation to be in because if you define an outcome by the need for another treatment, well, that particular group are a high risk group because we know that we’re leaving a tiny amount of cancer there that’s possibly going to get worse in the future. But being prepared to do that because they’re confident that we’re going to monitor them closely and if necessary, treat them again with a minimal morbidity. I think when you’re doing studies, it’s really hard to compare apples to apples because you generally have groups of patients who are very diverse and clinicians that are diverse and you’re getting sort of quite a few varies. But the point I’m making is if you are showing benefit with that diverse group, then you can imagine how much better it’s going to be for the very select group when the treatment is done properly.
Clare Delmar
Yeah. Again, very interesting way of looking at it, because we’re always wondering how and when focal therapy will kind of go mainstream, so to speak. And I was going to ask you, do you see focal therapy playing a more significant role in educating men about their treatment options for prostate cancer? Or I guess. In other words. Do you think the urology community is developing more of a literacy around it and adding it to active surveillance, hormone therapy, radical prostate radiotherapy in the treatment portfolio?
Alan Doherty
I think what focal therapy does is make you realise how important a good MRI scan is because a good MRI scan and good interpretation of that MRI scan by a very experienced radiologist. What that does is it allows you to do the focal therapy. But if you go one step back, it means that you’re not going to biopsy patients who have a normal MRI scan. In other words, if you’re confident in your MRI scan, you can really reduce the number of biopsies you ask for. So it will stop people being scared of having a PSA, because traditionally, if you had a PSA blood test and it was a little bit abnormal, you’d end up having a biopsy. So what I’m saying is, I suppose when you are offering focal therapy, you’re the type of clinician that’s not going to be biopsying people just because the PSA is slightly elevated. You’re going to be looking for early significant lesions that you can see. Focal therapy is all about seeing the lesion, hoping that it’s only in a focal area and then treating it accordingly, and you have to pick it up early so that you can get good outcomes from it. And I think that’s where it’s going. That the focal therapy is a natural consequence of a high quality MRI service. I agree that’s going to be hard to do because it’s a difficult one to do, that one. But with time, it’s relatively new that MRI scans become a dominant feature in prostate cancer management. And you can imagine, therefore, that if something is new, it’s going to take time to really develop. You’re going to have certain pockets of excellence and you’re going to have people catching up with that and then you’re going to have certain pockets where they need to pull their socks up a bit.
Clare Delmar
But I mean, picking up on your point about doing no harm and the benefit of early screening, I’ve heard you say in the past that now that you do have this highly precise MRI, which is only getting better and better. If you can see these cancers and you can define their severity, their location, their size, is it better to treat it than, for example, to do nothing? Is that the role of focal therapy? Is that how you see it?
Alan Doherty
That’s exactly how I see it. Because maybe you are over treating people, but that goes for all screening programmes and the trick is to over treat someone… sorry the trick is to try to avoid overtreating. But if you are going to, don’t give them side effects.
Alan Doherty
Yeah, no, absolutely. I guess on that point, that’s really good news. That often doesn’t translate down to the patient level because they often sort of undergo an MRI scan, for example, without fully understanding the significance. They might know that it’s obviously going to aid in their… well, as you say, whether or not they did a biopsy or not. But then later on some form of diagnosis. But I guess connecting that to they might be able to have less radical treatment because this new method allows that is probably something that needs to be educated.
Alan Doherty
And I think one of the last things to just mention is that people who do focal therapy probably are best as clinicians who don’t just do focal therapy do a number of different treatments because every treatment has its limitation.
Clare Delmar
Of course.
Alan Doherty
The more you do it, the more you understand those limitations and the better able you are to advise the patient as to what’s best for them because it’s not necessarily just the short term outcomes that matter, it’s also the long term outcome. So it’s quite a complex area, but a good clinician should be able to explain the issues. And every patient is different and has a different personality and has a different value system. So it’s quite fun being a clinician in this day and age because we’ve got so many different ways to treat people increasingly without making them miserable when just giving them benefit.
Clare Delmar
Yeah, and so much more information on which to make those decisions and have those conversations.
Alan Doherty
Exactly.
Clare Delmar
So I guess as a final question, what are the reasons to be cheerful if you’re a man over 50 and you’re faced with the fact that, oh, I’ve got to go get a PSA test, for some men, this actually makes them quite hesitant, even reticent about getting one. But from what you’re saying there’s, early screening can lead to, well, you tell me, what are the reasons to be cheerful if you’re a man over 50?
Alan Doherty
Well, I think that if somebody was to encourage a patient to have a PSA blood test, they should be confident that we’re only going to pick up a significant cancer that’s going to be seen. In other words, that the MRI scans normal, we don’t biopsy, and then if we do see something, we’re going to pick it up early enough that we can affect the natural history. In other words, that we can make a difference and stop you having to have treatment in the future that have a lot of side effects and even better than that, possibly even stop you dying from it. But it’s not just about living and dying. I often say to patients that it’s not just about being alive, you’ve got to live. It’s that combination of quality of life and quantity of life. I think the reason to be confident and positive about the future is that high quality MRI scan and a focal therapy just allows you to pick up and treat early tumours before they are really dangerous. And that’s got to be what screening is all about.
Clare Delmar
Well, on that note, I’m going to say thank you so much for sharing your optimism and giving us some really useful pieces of information about how some of this diagnostic information is really transforming what you can offer patients and how they’re going to recover.
Alan Doherty
Pleasure. I’m so glad you do these to share information with people because there is so much out there now and it’s confusing to patients.
Clare Delmar
Well, it’s great that you can actually help make it a lot more not simplistic, but a lot more easy to digest and, as you say, a reason to be cheerful. So thanks again for coming, Alan.
Alan Doherty
Thank you, Clare.
Clare Delmar
Further information on Alan and his clinical practise is available on our website, along with the transcript of this interview and additional interviews and stories about living with prostate cancer, please visit www.thefocaltherapyclinic.co.uk and follow us on Twitter and Facebook at The Focal Therapy Clinic. Thanks for listening and from me, Clare Delmar, see you next time. Bye.
