Am I Suitable for Focal Therapy?

Mr. Marc Laniado: **Focal therapy** is an excellent treatment option **if both the tumor and the patient are suitable for it**. ### **Tumor Criteria for Focal Therapy** - The cancer should be **low-risk to intermediate-risk** (**ISUP Grade 1–3**). - It should be **localized in one part of the prostate**, rather than widespread. - The tumor **must be visible on an MRI scan**—if we can see it, we can almost always **treat it with focal therapy**. ### **Patient Considerations for Focal Therapy** Focal therapy is a good option for men who: - **Prioritize maintaining urinary continence and erectile function**. - Want to **avoid the side effects of surgery or radiotherapy**. - Are comfortable with **a small trade-off in certainty of cancer cure** in exchange for **better quality of life**. However, if a patient values **complete cancer removal at all costs**, even if it means higher risks of **urinary incontinence or erectile dysfunction**, then **surgery or radiotherapy may be a better option**. For men who want to **balance cancer control with minimal impact on daily life**, **focal therapy is a strong alternative to consider**.

Mr. Tim Dudderidge: **Focal therapy is generally not used for metastatic prostate cancer**, except in the context of a **clinical trial**. ### **Metastatic Prostate Cancer & Focal Therapy** - The **only situation where focal therapy may be useful** is within a **clinical trial**. - We are currently running the **ATLANTIS study**, where we use **minimally invasive focal therapy** alongside **systemic treatments like hormone therapy**. - This is still **experimental**, but it may play a role in the future. ### **Focal Therapy for Locally Advanced Disease** - **Locally advanced prostate cancer** occurs when the tumor is **bulging slightly beyond the prostate capsule**. - In **select cases**, focal therapy **may be considered** if: - The patient **does not want** surgery or radiotherapy. - There are **contraindications to surgery or radiotherapy**. - However, the **success rates of focal therapy in locally advanced disease may be lower** than in localized cases. Each case is **discussed in our multidisciplinary team (MDT) meetings**, ensuring that **focal therapy is only offered when appropriate** for advanced cases.

Mr. Alan Doherty: When I’m asked, **Am I too old for focal therapy?**, the first thing I consider is: **Do you need treatment at all?** - The key question is: **What are we trying to achieve?** - If you **can’t answer that**, then treatment may **not** be necessary. **The goal of treatment is to prevent cancer from progressing** and causing **future symptoms**. ### **When Treatment May Not Be Needed** - If you’re **90 years old** with **heart disease**, treating an **early-stage prostate cancer** is **not appropriate**—it **shouldn’t have been found in the first place**. ### **When Treatment Makes Sense** - If you’re **younger and healthy**, treatment is **more relevant**. - **Age alone is not the deciding factor**—it’s about: - **How aggressive the cancer is**. - **Your overall health**. - **How many more years you are expected to live**. So rather than saying someone is **too old for focal therapy**, the better approach is to assess whether the **cancer truly needs treatment** and if the person is **healthy enough to benefit from it**.

Mr. Alan Doherty: **NanoKnife is a highly targeted focal therapy** that is particularly effective for **prostate cancers located at the front of the gland**. ### **Why Is NanoKnife Preferred for Anterior Tumors?** - **HIFU does not always deliver enough energy** to the **front (anterior) of the prostate**. - The effectiveness of **HIFU depends on prostate size**, and it may not be as precise in this location. - **NanoKnife excels at targeting anterior tumors**, making it the **preferred option** for these cases. For men with **cancers at the front of the prostate**, **NanoKnife provides a precise, minimally invasive treatment** that preserves healthy tissue while effectively ablating the tumor.