What is Focal Therapy for Prostate Cancer?

Treatment Option 1: HIFU (High-Intensity Focused Ultrasound)

NICE Procedure Codes: IPG424, IPG756

Procedure Type: Therapeutic, non-invasive

Technology: Focused ultrasound waves to heat and destroy cancer cells

Best For: Tumours located toward the back (posterior) of the prostate

Delivery Method: No needles inserted into the prostate - ultrasound probe placed in rectum

Treatment Duration: 60-90 minutes under general anaesthesia

Treatment Option 2: Cryotherapy

Procedure Type: Therapeutic, needle-based

Technology: Freezes cancerous tissue to destroy the tumour

Best For: Tumours located toward the front (anterior) of the prostate

Delivery Method: Probes inserted into prostate to freeze cancerous tissue

Treatment Duration: 60-90 minutes under general anaesthesia

Treatment Option 3: NanoKnife IRE (Irreversible Electroporation)

NICE Procedure Code: IPG443

Procedure Type: Therapeutic, needle-based

Technology: Electrical pulses create microscopic holes in cancer cells causing cell death

Best For: Anterior tumours that HIFU may not reach as effectively

Delivery Method: Needles inserted to deliver electrical pulses

Treatment Duration: 60-90 minutes under general anaesthesia

Before the Procedure

Patient arrives at hospital having fasted

Pre-procedure checks performed by nursing staff

Enema may be given to clear bowels for better ultrasound imaging

General anaesthesia administered in operating theatre

During the Procedure

Positioning: Lithotomy position for perineal access

Transrectal ultrasound probe placed in rectum

For HIFU: Probe also delivers treatment

For Cryotherapy and NanoKnife: Probe used for imaging only

Ultrasound images linked to MRI scan using fusion technology

HIFU: Focused ultrasound delivered in overlapping zones (3-4 sessions)

Cryotherapy: Needles inserted to freeze cancerous tissue

NanoKnife: Needles inserted to deliver electrical pulses

Catheter placed in bladder at end of procedure

After the Procedure

Recovery room: Approximately 30 minutes before returning to ward

Food and drink given once fully awake

Catheter management instruction provided by nurses

Discharge: Most patients go home within a few hours

Transport: Someone must drive patient home (cannot drive for 36 hours after anaesthesia)

First 48 Hours

Light activities including walking encouraged

Cannot drive for 36 hours after general anaesthesia

Mild discomfort, bladder spasms, or increased urinary frequency possible

Symptoms managed with medications

First Week (Catheter In Place)

Catheter remains in place for 5-7 days

Most light activities possible, including working from home

Office-based workers often return to work within a few days

After Catheter Removal

Return to normal physical activities including sports within one week

Bladder function normalisation may take a few weeks

Temporary urgency or frequency possible

Long-term Recovery (3-6 Months)

Erectile function: Most men regain normal erections within 3-6 months

Support available: Low-dose erectile function medications like Tadalafil (Cialis)

Urinary function: Full continence typically restored within weeks

Incontinence: Less than 1% experience long-term incontinence

Fatigue: Mild fatigue resolves with rest and gradual return to activity

Comparison to Other Treatments

Focal Therapy Recovery: Same-day discharge, catheter 5-7 days, return to activities within 1-2 weeks

Radical Surgery Recovery: Hospital stay several days, catheter 1-2 weeks, recovery period 4-6 weeks

Radiotherapy: No hospital stay, but treatment spread over 4-8 weeks with side effects developing over time

Common Side Effects (Temporary)

Increased urinary frequency or urgency - usually resolves within a few weeks

Mild discomfort in the perineum - typically lasts 2-3 days

Blood in urine or semen - can persist for a few weeks

Temporary erectile dysfunction - most men regain function within 3-6 months with medication support

Less Common Side Effects

Urinary retention - may require catheter for a few days

Urinary tract infection (UTI) - treatable with antibiotics

Bladder spasms - managed with antispasmodic medications (Buscopan, Solifenacin)

Rare Side Effects

Persistent erectile dysfunction: 5-15% of cases depending on tumour location and nerve proximity

Incontinence: Very rare, affecting less than 1% of patients

Recto-urethral fistula: Extremely rare, more associated with cryotherapy

Side Effect Comparison

Focal Therapy Incontinence: Less than 1%

Radical Surgery Incontinence: 10-30%

Focal Therapy Erectile Dysfunction: 5-15%

Radical Surgery Erectile Dysfunction: 30-70%

Radiotherapy Erectile Dysfunction: 30-50%

Focal Therapy: Minimal side effects, significantly less severe and shorter duration than radical treatments

First Year

PSA Blood Tests: Conducted every 3 months to monitor PSA levels

MRI Scan: Performed at end of first year to ensure treated area has disappeared

Purpose: Verify no new abnormalities developed in remaining prostate tissue

Years 2-3

PSA Tests: Conducted every 6 months

Long-term Follow-up

Annual PSA Tests: Continued annually to monitor for signs of recurrence

Optional MRI Scans: Some men opt for additional MRI scans at 3 or 5 years

If Cancer Recurs

Recurrence Rate: 5-10% of cases where cancer not fully treated or recurs

Repeat Focal Therapy: Another session can be performed

Radical Treatment Options: Surgery (radical prostatectomy) or radiotherapy available if needed

Advantage: Focal therapy does not prevent later radical treatments if necessary

Consultant 1: Mr Tim Dudderidge

Full Name: Mr Tim Dudderidge

Job Title: Consultant Urologist

Professional Credentials: FRCS (Urol), MD, MBBS

Profile URL: https://www.thefocaltherapyclinic.co.uk/consultants/tim-dudderidge/

Video Appearances: 8 videos (most featured consultant)

Topics Covered: Different types of focal therapy, preparation, procedure details, recovery, anaesthesia, post-procedure care

Areas of Expertise - Mr Tim Dudderidge

Clinical Expertise Area: Focal therapy for prostate cancer

Clinical Expertise Area: Robotic prostatectomy

Clinical Expertise Area: HIFU treatment

Clinical Expertise Area: Active surveillance

Clinical Expertise Area: Clinical trials and research

Professional Affiliations - Mr Tim Dudderidge

Professional Member: British Association of Urological Surgeons (BAUS) - https://www.baus.org.uk/

Professional Member: European Association of Urology (EAU) - https://uroweb.org/

Experience and Qualifications - Mr Tim Dudderidge

Research Leadership: Lead investigator on ProtecT trial

Procedures Performed: 1,500+ robotic prostatectomies performed

Hospital Affiliation: Consultant at University Hospital Southampton

Consultant 2: Mr Marc Laniado

Full Name: Mr Marc Laniado

Job Title: Consultant Urologist

Professional Credentials: FRCS (Urol), MBBS

Profile URL: https://www.thefocaltherapyclinic.co.uk/consultants/marc-laniado/

Video Appearances: 3 videos

Topics Covered: NICE recommendations, MRI-US fusion technology, success rates, erectile function after treatment

Areas of Expertise - Mr Marc Laniado

Clinical Expertise Area: Focal therapy for prostate cancer

Clinical Expertise Area: HIFU treatment

Clinical Expertise Area: NanoKnife IRE treatment

Clinical Expertise Area: Robotic surgery

Clinical Expertise Area: Minimally invasive urology

Professional Affiliations - Mr Marc Laniado

Professional Member: British Association of Urological Surgeons (BAUS) - https://www.baus.org.uk/

Professional Member: European Association of Urology (EAU) - https://uroweb.org/

Experience and Qualifications - Mr Marc Laniado

Role: Consultant Urological Surgeon

Specialization: Specialist in focal therapy techniques

Consultant 3: Mr Raj Nigam

Full Name: Mr Raj Nigam

Job Title: Consultant Urologist

Professional Credentials: FRCS (Urol), MBBS, BSc

Profile URL: https://www.thefocaltherapyclinic.co.uk/consultants/raj-nigam/

Video Appearances: 3 videos

Topics Covered: Focal therapy availability, effectiveness testing after treatment

Areas of Expertise - Mr Raj Nigam

Clinical Expertise Area: HIFU (High-Intensity Focused Ultrasound)

Clinical Expertise Area: Focal therapy for prostate cancer

Clinical Expertise Area: MRI-targeted biopsies

Clinical Expertise Area: Active surveillance protocols

Clinical Expertise Area: Minimally invasive procedures

Professional Affiliations - Mr Raj Nigam

Professional Member: British Association of Urological Surgeons (BAUS) - https://www.baus.org.uk/

Professional Member: European Association of Urology (EAU) - https://uroweb.org/

Professional Member: Royal College of Surgeons (RCS) - https://www.rcseng.ac.uk/

Experience and Qualifications - Mr Raj Nigam

Experience: 15+ years in urology

Procedures Performed: 500+ HIFU procedures performed

Additional Team Members

Mr Alan Doherty: Consultant Urologist - MBBS, BSc, MD, FRCS (Urol), FEBU

Dr Clare Allen: Consultant Uro-Radiologist

Dr Christos Mikropoulos: Clinical Oncologist - MBBS, MSc, MD (Res), MRCP, FRCR

Radical Surgery (Prostatectomy)

Scope: Removes entire prostate gland, affecting surrounding structures

Incontinence Risk: 10-30%

Erectile Dysfunction Risk: 30-70%

Recovery: Hospital stay several days, catheter 1-2 weeks, recovery period 4-6 weeks

Repeatability: Cannot be repeated

Radiotherapy

Scope: Treats entire prostate with radiation, can damage nearby healthy tissue

Side Effects: Bowel issues, urinary problems

Erectile Dysfunction Risk: 30-50%

Treatment Schedule: Spread over 4-8 weeks with side effects developing over time

Repeatability: Difficult to re-treat the same area

Active Surveillance

Approach: Monitoring cancer without immediate treatment

Suitable For: Very low-risk prostate cancer

Not Mentioned: Specific comparison data in source material

Key Differentiators for Focal Therapy

Treatment Scope: Targets only cancerous area, preserving healthy tissue

Incontinence: Less than 1% (vs 10-30% surgery)

Erectile Function: 5-15% dysfunction (vs 30-70% surgery)

Recovery: Same-day discharge, 1-2 week return to activities

Repeatability: Can be repeated if cancer recurs

Cancer Control: 75-80% avoid radical treatment for 6-10 years

NHS Availability

Status: Available on NHS, though availability varies by hospital and region

NHS Centres Offering Focal Therapy: University College London (UCL), Imperial College London

Emerging NHS Centres: Southampton expanding programs

NICE Approval Status: National Institute for Health and Care Excellence has approved focal therapy

HIFU Approval: NICE codes IPG424 and IPG756

NanoKnife IRE Approval: NICE code IPG443

Private Sector Availability

History: Focal therapy widely available in private sector for many years

Insurance Coverage: All major insurance companies cover focal therapy under specific procedure codes

The Focal Therapy Clinic: Treats both NHS and private patients

Access: Ensures all men have access to this advanced treatment option

FAQ: What is Focal Therapy for Prostate Cancer?

Answer: Focal therapy is a minimally invasive treatment for localised prostate cancer that targets only the cancerous tissue while preserving the healthy parts of the prostate. This approach aims to effectively treat the cancer while minimising side effects commonly associated with more invasive treatments like radical prostatectomy or radiotherapy. At The Focal Therapy Clinic, we specialise in multiple forms of focal therapy, including HIFU (High-Intensity Focused Ultrasound), Cryotherapy, and NanoKnife (Irreversible Electroporation).

FAQ: What are the three main types of Focal Therapy?

Answer: The three main types of focal therapy for prostate cancer are: HIFU (High-Intensity Focused Ultrasound): Uses focused ultrasound waves to heat and destroy cancer cells. It is non-invasive, with no needles inserted into the prostate. HIFU is most effective for tumours located toward the back of the prostate. Cryotherapy: A needle-based therapy that freezes cancerous tissue, destroying the tumour while preserving healthy structures. It works well for tumours located toward the front of the prostate. NanoKnife (Irreversible Electroporation, IRE): A needle-based therapy using electrical pulses to create microscopic holes in cancer cells, causing them to die. It is effective for anterior tumours that HIFU may not reach as well.

FAQ: How does Focal Therapy work?

Answer: Focal therapy works by precisely targeting and destroying cancerous tissue within the prostate while leaving healthy tissue intact. This is achieved using advanced imaging techniques, such as MRI-ultrasound fusion, to accurately locate the tumour. Depending on the type of focal therapy used: HIFU: Uses focused ultrasound waves to heat and destroy cancer cells. The ultrasound probe is placed in the rectum, and the treatment is delivered without needles. Cryotherapy: Involves inserting probes into the prostate that freeze the cancerous tissue, effectively destroying it. NanoKnife (IRE): Uses electrical pulses delivered through needles to disrupt cancer cells at the cellular level. Throughout the procedure, real-time imaging ensures the treatment targets only the cancerous area, with a margin around it to capture any microscopic disease. The entire process typically lasts 60-90 minutes under general anaesthesia, and a catheter is placed at the end to aid recovery.

FAQ: Who is eligible for Focal Therapy?

Answer: Focal therapy is typically suitable for men with localised prostate cancer, meaning the cancer is confined within the prostate gland. Eligibility depends on several factors, including: Cancer Stage: Early or intermediate-stage prostate cancer (T1 or T2). Gleason Score: Typically 7 or lower (3+4 or 4+3). Tumour Location: The cancer must be clearly visible on an MRI scan and localised to a specific area of the prostate. PSA Levels: Generally for men with a PSA level that suggests localised disease. General Health: Patients should be fit enough to undergo a procedure under general anaesthesia. If you have advanced cancer, widespread disease, or a Gleason score above 7, focal therapy may not be suitable. Our expert urologists will assess your individual case, review your PSA levels, MRI scans, and biopsy results during your initial consultation to determine if focal therapy is the right option for you.

FAQ: What are the success rates and outcomes of Focal Therapy?

Answer: Focal therapy has demonstrated strong success rates for men with localised prostate cancer. The outcomes vary based on the treatment type, tumour characteristics, and patient factors, but research shows: At The Focal Therapy Clinic, we use MRI-ultrasound fusion technology to enhance treatment accuracy, which improves success rates: Over 90% of men are cancer-free at one year based on MRI and PSA criteria. Globally, 75-80% of men remain free from needing radical treatment (surgery or radiotherapy) for 6-10 years after focal therapy. The clinic's data, based on a review of 270 patients, shows: 90% of clinically significant cancer is eliminated at one year. 99% of men are fully continent (no incontinence issues). 85% of men retain erections suitable for intercourse.

FAQ: What are the side effects of Focal Therapy?

Answer: Focal therapy is designed to minimise side effects by targeting only the cancerous tissue while preserving healthy structures. However, some side effects may occur: Common Side Effects (Temporary): Increased urinary frequency or urgency – usually resolves within a few weeks. Mild discomfort in the perineum – typically lasts 2-3 days. Blood in urine or semen – can persist for a few weeks. Temporary erectile dysfunction – most men regain function within 3-6 months, especially with support like low-dose erectile function medications. Less Common Side Effects: Urinary retention – requiring a catheter for a few days. Urinary tract infection (UTI) – treatable with antibiotics. Bladder spasms – managed with antispasmodic medications like Buscopan or Solifenacin. Rare Side Effects: Persistent erectile dysfunction (5-15% of cases, depending on tumour location and nerve proximity). Incontinence (very rare, affecting less than 1% of patients). Recto-urethral fistula (extremely rare, more associated with certain types of focal therapy like cryotherapy). Most side effects are significantly less severe and shorter in duration than those associated with radical treatments like surgery or radiotherapy.

FAQ: How is Focal Therapy different from radical surgery or radiotherapy?

Answer: Focal therapy differs from radical surgery (prostatectomy) and radiotherapy in several key ways: Treatment Scope: Focal Therapy: Targets only the cancerous area of the prostate, preserving healthy tissue. Radical Surgery: Removes the entire prostate gland, affecting surrounding structures. Radiotherapy: Treats the entire prostate with radiation, which can damage nearby healthy tissue. Side Effects: Focal Therapy: Minimal side effects, with low rates of incontinence (less than 1%) and erectile dysfunction (5-15%). Radical Surgery: Higher risk of incontinence (10-30%) and erectile dysfunction (30-70%). Radiotherapy: Can cause bowel issues, urinary problems, and erectile dysfunction (30-50%). Recovery Time: Focal Therapy: Most patients go home the same day, with catheter removal within 5-7 days. Radical Surgery: Requires a hospital stay of several days, with a catheter for 1-2 weeks and a recovery period of 4-6 weeks. Radiotherapy: No hospital stay, but treatment is spread over 4-8 weeks, with side effects developing over time. Repeatability: Focal Therapy: Can be repeated if cancer recurs or is incompletely treated. Radical Surgery: Cannot be repeated. Radiotherapy: Difficult to re-treat the same area. Cancer Control: Focal Therapy: Effective for localised cancer, with 75-80% of men avoiding radical treatment for 6-10 years. Radical Surgery & Radiotherapy: May offer slightly higher long-term cancer control rates but at the cost of greater side effects.

FAQ: What happens during the Focal Therapy procedure?

Answer: The focal therapy procedure is performed under general anaesthesia and typically lasts 60-90 minutes. Here's what happens: Before the Procedure: Arrival: You'll arrive at the hospital having fasted (no food or drink for several hours). Pre-Procedure Checks: Nursing staff will perform necessary checks, and you may be given an enema to clear the bowels for better ultrasound imaging. Anaesthesia: You'll be placed under general anaesthesia in the operating theatre. During the Procedure: Positioning: Your legs will be positioned in lithotomy (similar to a gynecological exam) to allow access to the perineum. Imaging & Planning: A transrectal ultrasound probe is placed in the rectum. For HIFU, this probe also delivers the treatment. For cryotherapy and NanoKnife, it is used for imaging only. The ultrasound images are linked to your MRI scan using MRI-ultrasound fusion technology to precisely locate the tumour. Treatment: HIFU: Focused ultrasound waves are delivered in overlapping zones (typically 3-4 sessions) to heat and destroy cancer cells. Cryotherapy: Needles are inserted into the prostate to freeze the cancerous tissue. NanoKnife: Needles are inserted to deliver electrical pulses that destroy cancer cells. Catheter Placement: A catheter is placed in the bladder at the end of the procedure to help drain urine during recovery. After the Procedure: Recovery Room: You'll wake up in the recovery room, where you'll spend about 30 minutes before returning to the ward. Eating & Drinking: Once fully awake, you'll be given food and drink. Catheter Management: Nurses will show you how to manage the catheter. Going Home: Most patients go home within a few hours, though someone must drive you, as you cannot drive for 36 hours after general anaesthesia.

FAQ: How long does recovery take after Focal Therapy?

Answer: Recovery after focal therapy is typically quick compared to radical treatments: First 48 Hours: You can resume light activities, including walking, which is encouraged. You cannot drive for 36 hours after general anaesthesia. You may experience mild discomfort, bladder spasms, or increased urinary frequency, which can be managed with medications. First Week (Catheter In Place): The catheter remains in place for 5-7 days. You can engage in most light activities, including working from home (if your job is not physically demanding). Office-based workers often return to work within a few days. After Catheter Removal: Most men can return to normal physical activities, including sports, within a week of catheter removal. Bladder function may take a few weeks to fully normalise, with some men experiencing temporary urgency or frequency. Long-Term Recovery: Erectile function: Most men regain normal erections within 3-6 months, especially with the help of low-dose erectile function medications like Tadalafil (Cialis). Urinary function: Full continence is typically restored within weeks, with less than 1% of men experiencing long-term incontinence. Fatigue: Some men experience mild fatigue after treatment, which resolves with rest and gradual return to normal activity. Overall, recovery is much faster than radical surgery (4-6 weeks) or radiotherapy (ongoing side effects over months).

FAQ: What follow-up care is required after Focal Therapy?

Answer: Follow-up care after focal therapy is essential to monitor treatment success and detect any recurrence. At The Focal Therapy Clinic, we provide comprehensive follow-up care: First Year: PSA Blood Tests: Conducted every 3 months to monitor PSA levels. MRI Scan: Performed at the end of the first year to ensure the treated area has disappeared and no new abnormalities have developed in the remaining prostate tissue. Years 2-3: PSA Tests: Conducted every 6 months. Long-Term Follow-Up: Annual PSA Tests: Continued annually to monitor for any signs of recurrence. Optional MRI Scans: Some men opt for additional MRI scans at 3 or 5 years for further reassurance. What Happens If Cancer Recurs? In the 5-10% of cases where cancer is not fully treated or recurs in another part of the prostate, additional treatment options are available: Repeat Focal Therapy: Another session of focal therapy can be performed. Radical Treatment: Surgery (radical prostatectomy) or radiotherapy can be pursued if needed. The advantage of focal therapy is that it does not prevent you from having these treatments later if necessary.

FAQ: Is Focal Therapy available on the NHS?

Answer: Yes, focal therapy is available on the NHS, though availability may vary depending on the hospital and region. NHS Availability: Focal therapy is offered at certain NHS centres, including: University College London (UCL) Imperial College London Emerging centres like Southampton, which are expanding their programs. NICE Approval: The National Institute for Health and Care Excellence (NICE) has approved focal therapy for certain types of prostate cancer. HIFU has been approved under IPG424 and IPG756. NanoKnife (Irreversible Electroporation) has been approved under IPG443. Private Sector: Focal therapy has been widely available in the private sector for many years. All major insurance companies cover focal therapy under specific procedure codes. At The Focal Therapy Clinic, we treat both NHS and private patients, ensuring all men have access to this advanced treatment option. If you are considering focal therapy, you can discuss with your GP or urologist whether it is available through the NHS in your area, or you can opt for private treatment.

Video Playlist 1: Availability (3 Videos)

Video 1: What are the NICE recommendations for focal therapy

Medical Expert: Mr Marc Laniado (FRCS (Urol), MBBS)

Duration: 54 seconds

NICE Codes Mentioned: IPG756 (HIFU), IPG424 (HIFU), IPG443 (NanoKnife)

Video 2: Where is Focal Therapy Available

Medical Expert: Mr Raj Nigam (FRCS (Urol), MBBS, BSc)

Duration: 1 minute

Video 3: What are the different types of focal therapy

Medical Expert: Mr Tim Dudderidge (FRCS (Urol), MD, MBBS)

Duration: 1 minute 23 seconds

Video Playlist 2: Care - Before Treatment (1 Video)

Video: How should I prepare for focal therapy

Medical Expert: Mr Tim Dudderidge

Duration: 25 seconds

Video Playlist 3: Care - On the Day (3 Videos)

Video 1: What happens on the day of a focal therapy treatment?

Medical Expert: Mr Tim Dudderidge

Duration: 1 minute 37 seconds

Video 2: Do I need a general anaesthetic for focal therapy

Medical Expert: Mr Tim Dudderidge

Duration: 46 seconds

Video 3: What happens during focal therapy

Medical Expert: Mr Tim Dudderidge

Duration: 1 minute 38 seconds

Video Playlist 4: Care - Recovery (3 Videos)

Video 1: Recovery after focal therapy

Medical Expert: Mr Tim Dudderidge

Duration: 1 minute 4 seconds

Video 2: How long does it take to recover from focal therapy

Medical Expert: Mr Tim Dudderidge

Duration: 1 minute 25 seconds

Video 3: Will I need to wear a pad after focal therapy

Medical Expert: Mr Tim Dudderidge

Duration: 32 seconds

Video Playlist 5: Care - After Your Treatment (3 Videos)

Video 1: When can I go home after focal therapy

Medical Expert: Mr Tim Dudderidge

Duration: 40 seconds

Video 2: Will I need help getting or maintaining an erection after focal therapy

Medical Expert: Mr Marc Laniado

Duration: 41 seconds

Video 3: After focal therapy what tests are done to see if it was effective

Medical Expert: Mr Raj Nigam

Duration: 1 minute 38 seconds

Standalone Video: MRI-US Fusion Technology

Video: MRI US Fusion technology and focal therapy success rates

Medical Expert: Mr Marc Laniado

Duration: 1 minute

Topic: MRI fusion technology improving accuracy to 90%+ success rates

Video Distribution by Consultant

Mr Tim Dudderidge: 8 videos (57% of content)

Mr Marc Laniado: 3 videos (21% of content)

Mr Raj Nigam: 3 videos (21% of content)

Average Video Duration: Approximately 55 seconds