Focal therapy – for HCPs

About focal therapy

Focal therapy is a collective term for procedures that target just the tumour within your patient’s prostate, as opposed to removing the whole gland. Minimally invasive focal therapies for prostate cancer, using high-intensity ultrasound (HIFU), irreversible electroporation (NanoKnife) and cryoablation (cryotherapy), have been shown to have similar outcomes to prostatectomy, with fewer side effects^2,3. They are also associated with a lower overall cost and improved quality of life for patients⁴.

Focal therapies have also been shown to be a potential alternative for patients recommended watchful waiting, due to their age or comorbidities⁶. There is no global consensus on which energy source is best for which situation, so patients should be referred to a consulting urologist with focal therapy experience⁷.

Focal therapy is only available at some NHS trusts and private hospitals, but it is covered by all major health insurers for those with medical insurance. At The Focal Therapy Clinic, we offer HIFU and NanoKnife, both of which are approved by NICE with special arrangements for governance, consent, and audit or research. These arrangements are satisfied via the HEAT and ICE registries.

Focal therapy requirements

For patients to be referred for focal therapy, they should generally satisfy the following requirements:

• Gleason score: <7
• PSA: <15
• Cancer is confined within the prostate gland⁵
• Have had an mpMRI scan and positive biopsy

References

1. Nguyen CT, Jones S. Focal therapy in the management of localized prostate cancer. BJU Int. 2011;107(9):1362-8.
2. Bakavicius A, Marra G, Maceket P et al. Available evidence on HIFU for focal treatment of prostate cancer: a systematic review. Int. Braz. J. Urol. 2022;48(2):263-274
3. Guo RQ, Guo XX, Li YM et al. Cryoablation, high-intensity focused ultrasound, irreversible electroporation, and vascular-targeted photodynamic therapy for prostate cancer: a systemic review and meta-analysis. Int. J Clin. Oncol. 2021;26(3): 461–84.
4. Reddy D, van Son M, Peters M et al. Focal therapy versus radical prostatectomy and external beam radiotherapy as primary treatment options for non-metastatic prostate cancer: results of a cost-effectiveness analysis. J. Med. Econ. 2023;26:1, 1099-1107.
5. Shah TT, Peters M, Eldred-Evans D et al. Early-medium-term outcomes of primary focal cryotherapy to treat nonmetastatic clinically significant prostate cancer from a prospective multicentre registry. Eur Urol. 2019;76(1):98–105.
6. Habashy D, Reddy D, Peters M et al. Evaluation of Outcomes Following Focal Ablative Therapy for Treatment of Localized Clinically Significant Prostate Cancer in Patients >70 Years: A Multi-institute, Multi-energy 15-Year Experience. J Urol. 2023;210(1):108-116
7. Ong S, Chen K, Grummet J et al. Guidelines of guidelines: focal therapy for prostate cancer, is it time for consensus? BJU Int. 2023; 131(1): 20–31.