What is Focal Therapy for Prostate Cancer?

Mr. Tim Dudderidge: ### **On the Day of Your Focal Therapy Procedure** 1. **Arrival & Pre-Procedure Preparation** - You will **arrive at the hospital starved**, ready for **general anesthesia**. - Nursing staff will **greet you and perform necessary checks**. - An **enema will be administered** to clear the bowels, ensuring a **clear ultrasound view** during treatment. 2. **Procedure Details** - You will be **transferred to the operating theater**, where final checks are completed. - Once the **anesthetist is happy**, you will be placed under **general anesthesia**. - The **procedure lasts 60–90 minutes**, during which the targeted prostate area is treated. 3. **Post-Procedure Recovery** - After the procedure, you will **wake up in the recovery room**, spending about **30 minutes there** before returning to the ward. - You will be given **food and drink** once fully awake. - A **catheter** will be attached to your leg, and **nurses will show you how to manage it**. 4. **Going Home & Recovery** - Once you have **fully recovered from anesthesia**, you can go home, but **someone must drive you** as you **cannot drive for 36 hours**. - **Normal activities can resume**, but the **catheter will stay in for 5–7 days**. - After **catheter removal**, most men can **return to normal life with minimal restrictions**. ### **Key Takeaway** Focal therapy is a **straightforward day-case procedure**, and **recovery is quick**, allowing patients to **resume daily life within a week**.

Mr. Tim Dudderidge: Nearly all patients can safely undergo the **general anesthesia required for a HIFU procedure**. ### **Anesthesia for Focal Therapy Treatments** - **HIFU (High-Intensity Focused Ultrasound)** - Requires **general anesthesia**. - **Spinal or regional anesthesia is not suitable**, as past attempts have not worked well. - This was learned from **early experiences**, and general anesthesia is now the standard. - **Cryotherapy** - Can potentially be performed under **spinal anesthesia**, but general anesthesia is preferred. - **NanoKnife (Irreversible Electroporation)** - Requires **general anesthesia** due to **muscle effects during the procedure**. For patients considering **focal therapy**, general anesthesia is **safe and well-tolerated in nearly all cases**, ensuring **optimal treatment conditions**.

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: After a **focal therapy procedure**, **pain is not typically a major symptom**. ### **Most Common Side Effect: Bladder Spasms** - The most frequent discomfort is **bladder spasms**—a **strong urge to urinate** even though the **catheter is draining properly**. - This symptom is usually **temporary**, lasting **24–48 hours**. - It can be managed with: - **Antispasmodic drugs** like **Buscopan (hyoscine butylbromide)**. - **More targeted bladder medications**, such as **Solifenacin**. ### **Managing Pain & Recovery** - **Pain is usually mild** and related to **bruising in the perineum**. - **Paracetamol and ibuprofen*

Mr Tim Dudderidge: After focal therapy, you can drive again after 48 hours as long as the catheter is not causing significant discomfort. However, if the catheter is bothersome or distracting, it is best to wait until it has been removed before driving. During the first week after treatment, you can engage in most light activities, and we encourage plenty of walking to stay active. Once the catheter is removed, patients can typically return to normal physical activities, including sports. I have had patients go skiing soon after catheter removal, and one even sent me a video of himself playing ice hockey just 10 days after treatment. Regarding work, recovery varies depending on your job. Many office-based workers are able to work on their laptops while still in the hospital. If you are self-employed, you may find it easy to return to work quickly. However, if your job is physically demanding, you might need a couple of weeks to adjust, as bladder behavior can be slightly more frequent or urgent at first. Beyond that, recovery is generally very quick. Some people experience mild fatigue after treatment, which can be surprising. It is important to listen to your body and gradually return to normal activity at a comfortable pace.

Mr. Tim Dudderidge (Consultant Urologist, The Focal Therapy Clinic): Typically, the reason men have to wear pads after surgery is due to sphincter damage, which can take a long time to heal. Occasionally, men may experience some frequency and urgency after focal therapy treatments, where an overactive bladder can lead to leakage just before reaching the toilet. For these men, wearing a pad is a temporary issue and usually short-lived.

Mr. Tim Dudderidge: Most patients **go home within a few hours** of returning to the ward after **focal therapy**. ### **What to Expect Before Discharge** - You’ll have time to **eat and drink**. - You’ll be **shown how to use the catheter**. - We’ll ensure you **don’t feel too groggy** before leaving. ### **Evening Procedures & Travel Considerations** - We often schedule procedures for the **late afternoon (Twilight list at 6:00 PM)**. - Even if treated late, **most patients can still go home that evening**, often around **9:00 PM**. - **For those traveling a long distance**, we may recommend **staying overnight in a local hotel** and traveling home the next morning. Most men **recover comfortably at home**, with clear instructions on **aftercare and follow-up**.

Mr. Marc Laniado: If you had **completely normal erections** before treatment, most men find that their **erections return within a few months** after focal therapy. ### **How to Support Recovery** I usually recommend taking a **low-dose erectile function medication. This helps: - **Boost blood flow to the nerves and penis**. - **Improve recovery and support erectile function return**. ### **What to Expect Over Time** - By **one year**, most men find their erections are **normal or close to normal**. - **Some men may need to continue taking medication** for erections even if they didn’t before. - **Very rarely**, men require additional treatments such as **injections or other interventions**, but this is uncommon. With **proper support and time**, **most men regain their sexual function after focal therapy**, maintaining a **high quality of life**.

Mr Raj Nigam: We carefully follow up with all our focal therapy patients. It is essential that after your treatment, you have access to us for ongoing monitoring. We track your progress in two ways. First, we conduct PSA blood tests every three months for the first year. Even if your PSA levels drop significantly and you feel completely fine, we always perform an MRI scan at the end of the first year. This ensures that the treated area has disappeared and that no new abnormalities have developed in the remaining prostate tissue. If everything looks good, we transition to six-monthly PSA tests for the next two years, followed by annual PSA checks. Many men also opt for another MRI scan at three or five years, which is entirely possible, though we primarily rely on PSA levels to guide further imaging needs. In the unfortunate 5–10% of cases where the cancer is not fully treated or returns in another part of the prostate, additional options are available. You can undergo another focal therapy session or pursue traditional treatments such as radical prostatectomy or radiotherapy if needed.