Which prostate cancer treatment has the fewest side effects?

Focal therapy has the lowest side effect rates among active treatments, with incontinence affecting less than 2% of patients compared to 5-20% after surgery, and erectile function preserved in over 90% versus 30-70% after radical prostatectomy. Among whole-gland treatments, surgery carries higher immediate risks to continence and erections, while radiotherapy causes bowel side effects in up to 20% of patients and gradual functional decline over years.

When is focal therapy preferred over radiotherapy or prostatectomy?

Focal therapy is ideal for localized, low-to-intermediate risk disease (Gleason 6-7, PSA 20 ng/mL or below) clearly visible on multiparametric MRI, where preservation of sexual and urinary function is a priority. It suits patients with life expectancy over 10 years who value maintaining future treatment options. Surgery may be preferred for higher-grade disease in younger patients, while radiotherapy suits those unable to undergo surgery or requiring combination with hormone therapy.

Can I have other treatments after focal therapy if needed?

Yes, focal therapy preserves all future treatment options. If cancer recurs, you can undergo repeat focal therapy, radiotherapy, or surgery with outcomes comparable to primary treatment. In contrast, surgery eliminates most future local treatment options, and radiotherapy limits subsequent surgical feasibility. This treatment flexibility represents modern cancer management — starting with the least invasive option while keeping more aggressive treatments available if needed.

How do I decide between HIFU and NanoKnife focal therapy?

HIFU uses focused ultrasound heat to destroy cancer cells and is ideal for posterior (lower/back) tumours away from the rectum. NanoKnife uses electrical pulses without heat and excels for anterior (front/upper) tumours near the urethra where thermal ablation carries higher risks. Both are NICE-approved with equivalent cancer control and functional preservation. Your consultant recommends the optimal technology based on your specific tumour location identified on MRI.

What are the recovery times for different prostate cancer treatments?

Focal therapy allows return to normal activities within 3-5 days, with catheter removal typically in 1-5 days and sexual activity resuming after 2-4 weeks. Radical prostatectomy requires 6-12 weeks full recovery, with hospital stay of 3-7 days and catheter for 10-14 days. Radiotherapy involves 6-8 weeks of daily hospital visits with cumulative fatigue. Active surveillance requires no recovery but involves ongoing monitoring appointments.

Which treatment best preserves sexual function?

Focal therapy preserves sexual function best, with over 90% of men maintaining erectile function by targeting only the cancerous area and avoiding damage to neurovascular bundles responsible for erections. Nerve-sparing prostatectomy achieves 30-70% preservation (highly surgeon-dependent), while radiotherapy preserves function in 40-70% initially but causes progressive vascular damage over years. For men under 70 with good baseline function who prioritize sexual health, focal therapy offers the highest probability of maintaining natural erections.

Who is a good candidate for each treatment type?

Active surveillance suits very low-risk disease (Gleason 6, PSA under 10 ng/mL). Focal therapy is ideal for localized, low-to-intermediate risk disease (Gleason 6-7, PSA 20 ng/mL or below) visible on MRI where quality of life preservation is paramount. Surgery may be recommended for higher-risk disease (Gleason 8+) in younger men who accept higher side effect risks. Radiotherapy suits those unable to undergo surgery or with higher-risk disease requiring hormone therapy combination. Approximately 50-60% of newly diagnosed patients are focal therapy candidates.

Is focal therapy as effective as surgery for cancer control?

For appropriately selected patients with localized disease, focal therapy demonstrates equivalent cancer control to radical treatments. Studies show 90% of clinically significant cancer eliminated at 1 year, with 75-80% of men avoiding radical treatment for 6-10 years. The 12% who experience recurrence can undergo repeat focal therapy or progress to surgery/radiotherapy with outcomes comparable to primary treatment. Long-term randomized trials comparing focal therapy to prostatectomy are underway, but current data supports focal therapy as definitive treatment for MRI-visible, intermediate-risk disease.

Home » Living with prostate cancer » Treatment Option

Prostate Cancer Treatment Options

There are several treatment options available for prostate cancer, each with its own benefits and risks. These are some of the factors that go into deciding your prostate cancer treatment

Cancer stage & grade: How advanced and aggressive the cancer is (e.g., Gleason score, PSA level).
Tumour location & spread: Whether it's confined to the prostate or has metastasised.
Patient preferences: Desire to avoid certain side effects (e.g., incontinence, erectile dysfunction).

Choosing the right treatment depends on cancer stage and individual patient factors.

Mr Raj Nigam, Lead Consultant

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Mr Raj Nigam explains what the treatment options are for prostate cancer

Prostate Cancer Treatment Options

HIFU

A successful non-invasive treatment that uses ultrasound waves to target and destroy cancerous tissue with precision

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NanoKnife

A successful minimally-invasive treatment that delivers electrical energy to target and destroy cancerous prostate tissue with precision

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Radiotherapy

One of the most common treatments for localised prostate cancer

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Prostatectomy

Removing your entire prostate gland, including the tumour

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Hormone therapy

Uses medicine to block or lower the levels of hormones

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Focal therapy

Focal therapy focuses on treating only the specific areas of the prostate affected by cancer

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Active surveillance and watchful waiting

The most common treatment options recommended when you are first diagnosed with prostate cancer

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Other treatments

Most common treatment options when diagnosed with prostate cancer

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Learn More About Prostate Cancer Treatment Options

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Mr. Raj Nigam: Does Focal Therapy work?

00:41

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SUMMARY

Mr. Raj Nigam (Consultant Urologist, The Focal Therapy Clinic): Focal therapy works, but not all men are suitable. Careful selection is crucial, with a detailed analysis ensuring that only the right candidates receive treatment for their specific cancer, maximizing effectiveness and safety. Mr. Raj Nigam - https://www.thefocaltherapyclinic.co.uk/about-us/our-consultants/mr-raj-nigam/ Focal Therapy - https://www.thefocaltherapyclinic.co.uk/focal-therapy/ suitability - https://www.thefocaltherapyclinic.co.uk/focal-therapy/medical-suitability/

TRANSCRIPT

Mr. Raj Nigam: ### **Does Focal Therapy Work?** Yes, **focal therapy is effective**—I wouldn’t have dedicated **18 years to this field if it didn’t work**. However, **not every man is suitable** for focal therapy. ### **How We Determine Suitability** - Many men **like the concept of focal therapy**, but careful **patient selection is critical**. - We spend significant time **analyzing existing medical data** or conducting **further assessments** to confirm whether a patient is a good candidate. - We ensure that the **treatment is tailored to the individual and their specific prostate cancer characteristics**. ### **A Highly Personalized Approach** Focal therapy is **not a one-size-fits-all treatment**—it is a **nuanced, carefully selected option** for the **right patients**. For those who qualify, **it offers excellent outcomes with minimal side effects**.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.

Mr Alan Doherty: What is a prostatectomy

00:39

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SUMMARY

Mr. Alan Doherty (Consultant Urologist, The Focal Therapy Clinic): Prostatectomy can be divided into two typesradical prostatectomy, which removes a margin for high-risk cancer, and total prostatectomy, which aims to minimize collateral damage for low-risk disease. Understanding these options helps patients choose the best surgical approach for their specific diagnosis. Alan Doherty - https://www.thefocaltherapyclinic.co.uk/about-us/our-consultants/mr-alan-doherty/ Prostatectomy - https://www.thefocaltherapyclinic.co.uk/living-with-prostate-cancer/treatment-options/prostatectomy/

TRANSCRIPT

Mr. Alan Doherty: I have always thought of **prostatectomy** as being divided into **two categories**: ### **1. Radical Prostatectomy (For High-Risk Cancer)** - Involves **removing the prostate with an extra margin of surrounding tissue**. - This **deliberate collateral damage** is necessary to ensure **complete cancer removal**. - It has a **higher side effect profile**, including **greater risks of incontinence and erectile dysfunction**. ### **2. Total Prostatectomy (For Low-Risk Cancer)** - Focuses on **removing only the prostate while preserving key structures**. - **Erectile nerves and the sphincter in the bladder neck are left intact**, minimizing functional side effects. - It is **better suited for low-risk prostate cancer**, where a **wider margin may not be necessary**. The **approach to prostatectomy depends on cancer severity**—for **high-risk cases, radical removal may be needed**, but for **low-risk cases, a more conservative approach can help preserve quality of life**.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.

Mr Raj Nigam explains what the treatment options are for prostate cancer

02:35

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SUMMARY

Mr. Raj Nigam (Consultant Urologist, The Focal Therapy Clinic): Prostate cancer is classified as localized, locally advanced, or advanced. Focal therapy is suitable for early localized cases, with treatment options including HIFU, cryotherapy, and NanoKnife. Choosing the right treatment depends on cancer stage and individual patient factors. Mr Raj Nigam - https://www.thefocaltherapyclinic.co.uk/about-us/our-consultants/mr-raj-nigam/ treatment options - https://www.thefocaltherapyclinic.co.uk/living-with-prostate-cancer/treatment-options/ book a consultation - https://www.thefocaltherapyclinic.co.uk/contact/ stages of prostate cancer - https://www.thefocaltherapyclinic.co.uk/blog/stages-of-prostate-cancer 00:00 Introduction: Assessing Prostate Cancer Stage 00:05 Step One: Localized vs. Spread Cancer 00:12 Prostate Cancer Stages Overview 00:13 Stage 1: Localized Prostate Cancer (All Treatments Possible) 00:20 Stage 2: Locally Advanced Prostate Cancer (Beyond the Capsule) 00:35 Stage 3: Advanced/Metastatic Prostate Cancer (Disease Control Focus) 00:50 Focal Therapy for Localized Prostate Cancer 01:07 Benefits of Focal Therapy: Minimally Invasive & Precise 01:36 HIFU: High-Intensity Focused Ultrasound (No Cuts or Scalpels) 01:43 Cryotherapy: Freezing the Tumor Through the Perineum 01:54 NanoKnife: Electroporation to Destroy Cancer Cells 02:16 Strong 5-Year Data Supporting NanoKnife (Australia) 02:19 Summary: Targeted Treatment, Preserved Quality of Life Website: https://www.thefocaltherapyclinic.co.uk LinkedIn: linkedin.com/company/the-focal-therapy-clinic/ Facebook: facebook.com/TheFocalTC Telephone: +44 (0) 207 036 8870 #FocalTherapy #ProstateCancer #HIFU #Cryotherapy #NanoKnife #MensHealth

TRANSCRIPT

Mr. Raj Nigam: The first step in managing prostate cancer is to determine **whether it is localized or has spread**. ### **Prostate Cancer Stages** 1. **Localized Prostate Cancer** - The cancer is **completely confined to the prostate**. - **All treatment options remain available**, including **focal therapy, radical prostatectomy, and radiotherapy**. 2. **Locally Advanced Prostate Cancer** - The cancer has **spread outside the prostate capsule**. - It may have **reached the seminal vesicles** or **nearby lymph nodes**. - Treatment is usually **whole-gland options like surgery or radiotherapy**. 3. **Advanced (Metastatic) Prostate Cancer** - The cancer has spread to **other organs or bones**. - Treatment focuses on **disease control rather than cure**. ### **Focal Therapy for Localized Prostate Cancer** For **early-stage prostate cancer**, focal therapy offers a **minimally invasive alternative** to radical treatments. **Three focal therapy options are now accepted:** 1. **HIFU (High-Intensity Focused Ultrasound)** - Delivered **through the rectum**, with **no cuts or scalpels**. 2. **Cryotherapy** - **Freezes the tumor** within the prostate. - Delivered **through the perineum**, the same route as biopsies. 3. **NanoKnife (Irreversible Electroporation)** - Uses **electrical pulses to destroy cancer cells**. - Delivered **through the perineum** like cryotherapy. - Supported by **strong 5-year data from Australia**. Focal therapy offers a **targeted treatment approach** for **localized prostate cancer**, preserving **quality of life while effectively treating the disease**.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.

Dr Christos Mikropoulos: What is radiotherapy for prostate cancer?

00:37

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SUMMARY

Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Radiotherapy is a widely used prostate cancer treatment, utilizing precision-shaped photon beams to target cancer while minimizing harm to surrounding tissues. This advanced approach ensures effective cancer control with reduced side effects. Christos Mikropoulos - https://www.thefocaltherapyclinic.co.uk/about-us/our-consultants/dr-christos-mikropoulos/ Radiotherapy - https://www.thefocaltherapyclinic.co.uk/living-with-prostate-cancer/treatment-options/radiotherapy/

TRANSCRIPT

Dr. Christos Mikropoulos: **Radiotherapy** is a widely used **treatment for prostate cancer**, performed throughout the world. ### **How Radiotherapy Works** - It uses **photon beams** to **precisely target and destroy prostate cancer cells**. - The beams are **carefully shaped** to ensure that they **treat the prostate while minimizing harm to surrounding tissues**. ### **Effectiveness & Side Effects** - **Radiotherapy is highly effective** in treating prostate cancer. - When delivered correctly, it has **fewer side effects** than older radiation techniques, improving patient outcomes. Radiotherapy continues to be a **leading option for prostate cancer treatment**, offering **curative potential while preserving quality of life**.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.

Dr Christos Mikropoulos What is hormone therapy

00:41

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SUMMARY

Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Hormone therapy suppresses male hormones to control prostate cancer. It has historically been used alongside radiotherapy to improve effectiveness, though this practice is evolving with newer treatment approaches. Understanding when hormone therapy is beneficial helps optimize patient outcomes.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.

Dr Christos Mikropoulos What is active surveillance

00:27

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SUMMARY

Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Active surveillance is a structured approach for low-risk prostate cancer, involving regular MRI scans, blood tests, and biopsies, with treatment given only if the cancer progresses. This strategy helps avoid unnecessary interventions while closely monitoring disease progression.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.

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Choosing Between Prostate Cancer Treatment Options

Treatment Type	Invasiveness	Side effects & Risks	Recovery Time	Ideal Candidate
Active Surveillance	Low	Minimal	Ongoing	Low-risk cases
Surgery	High	High	6-8 weeks	Localised Cancer
Radiation Therapy	Moderate	Moderate	4-6 weeks	Various Stages
Chemotherapy	High	High	Ongoing	Advanced Stages
Focal Therapy	Low	Low	1-2 weeks	Localised, intermediate-risk cancer

Learn More

Hear from some of our patients about the effect focal therapy has had on their lives.

Questions to ask your doctor or nurse

What treatment options are available for my stage and grade of cancer?

Ask about all available options for your specific diagnosis — including active surveillance, focal therapy (HIFU and NanoKnife), surgery, and radiotherapy. Your consultant should explain which options suit your cancer stage, Gleason score, and PSA level.

For detailed information about specific focal therapy options, see our HIFU treatment page and NanoKnife treatment page.

What are the side effects and how will treatment affect my quality of life?

Key questions include: How likely is incontinence or erectile dysfunction? How long is recovery? Will I need time off work? Can I return to normal activities?

Side effect profiles vary significantly between treatments. Focal therapy generally has the lowest side-effect rates, while surgery and radiotherapy carry higher risks to continence and sexual function.

How experienced is your clinic with the recommended treatment?

Key things to ask include how many procedures the clinic performs, the consultant's experience and GMC registration, whether MRI-fusion guidance is used, and whether the clinic publishes outcome data.

The Focal Therapy Clinic has completed more than 2,000+ focal therapy procedures, delivered by GMC-registered consultant urologists across seven UK centres.

What happens if my cancer comes back after treatment?

Ask about retreatment options and what your choices would be if cancer recurs. Focal therapy preserves the prostate, meaning repeat treatment or switching to surgery or radiotherapy remains possible. After surgery, the prostate is removed and retreatment options are more limited.

What follow-up schedule should I expect?

A typical schedule includes a PSA test and recovery check at six weeks, a PSA test and review at three months, another PSA test and possible MRI at six months, and a full MRI and possible biopsy at twelve months, followed by annual PSA monitoring.

You should contact the clinic urgently if you develop difficulty passing urine, symptoms of infection or ongoing pain.

Frequently asked questions

What are the main treatment options for prostate cancer?

The main treatment options for localised prostate cancer include:

Active Surveillance: Regular monitoring through PSA tests and MRI scans, suitable for low-risk, slow-growing cancers that may not require immediate treatment.

Focal Therapy: NICE-approved, minimally invasive treatments targeting only the cancerous tissue:
- HIFU: Uses focused ultrasound heat. Best for posterior tumours.
- NanoKnife IRE: Uses electrical pulses. Best for anterior tumours.

Radical Prostatectomy: Complete surgical removal of the prostate. Major surgery requiring 1–3 days hospital stay with 4–6 weeks recovery.

Radiotherapy: External beam radiation or brachytherapy delivered over multiple sessions. Non-surgical whole-gland approach.

Your consultant urologist will recommend options based on your cancer characteristics and personal circumstances.

How does focal therapy differ from surgery and radiation?

Focal therapy treats only the cancerous area, preserving healthy prostate tissue and greatly reducing side effects.

Key differences:

Outcome	Focal Therapy	Surgery	Radiation
Urinary continence	93–100% preserved	60–85% preserved	90–95% preserved
Sexual function	75–98% preserved	13–67% preserved	50–80% preserved
Recovery time	Days to 1–2 weeks	4–6 weeks	Varies
Hospital stay	Outpatient to 1 day	1–3 days	Outpatient

Research shows focal therapy achieves comparable 5-year cancer-specific survival (99–100%) to radical treatments while maintaining better quality of life.

Focal therapy is repeatable and keeps all future treatment options available.

When is active surveillance recommended?

Active surveillance is typically recommended for men with low-risk prostate cancer showing:
- Gleason score 6 (Grade Group 1)
- PSA under 10 ng/ml
- Small tumour volume
- Early stage disease (T1–T2a)

The protocol includes PSA tests every 3–6 months, regular MRI scans, and biopsies as needed. Treatment starts if the cancer shows progression.

Many men remain safely on surveillance for years, though 30–40% may eventually need treatment. For intermediate-risk patients, focal therapy offers an alternative.

What factors determine the right treatment option for me?

Several factors influence which treatment is best:

Cancer characteristics:
- Stage and Gleason score
- PSA level
- Tumour location (posterior suits HIFU; anterior suits NanoKnife)
- Number and size of lesions

Personal factors:
- Age and overall health
- Life expectancy (10+ years ideally)
- Current urinary and sexual function
- Other medical conditions

Your priorities:
- Preserving sexual function and continence
- Minimising recovery time
- Keeping future options open
- Cost and insurance considerations

Your consultant will assess MRI and biopsy results to recommend the most suitable approach.

Can I combine treatments or switch if needed?

Yes. One major advantage of focal therapy is preserving future treatment flexibility.

After focal therapy:
- Can be safely repeated (15–20% need retreatment within 5 years)
- All options remain open: repeat focal therapy, surgery, or radiotherapy
- Retreatment maintains good functional outcomes

After surgery:
- The prostate is removed
- Radiotherapy may treat recurrence
- No repeat procedure possible

After radiotherapy:
- Salvage options limited due to tissue changes
- Surgery carries higher risks after radiation

Focal therapy allows a “treat and preserve” approach, keeping your future options open.

Is HIFU available at your clinic, and how experienced is the team?

Ask about:
- Procedure volume
- Consultant experience and GMC registration
- MRI-fusion guidance technology
- Published outcomes
- Multi-disciplinary team access

The Focal Therapy Clinic team has performed over 2,000 focal therapy procedures across the UK, led by experienced GMC-registered urologists.

What are the success rates and potential side effects for my case?

Cancer control (focal therapy):
- 5-year cancer-specific survival: 99–100%
- 5-year metastasis-free survival: 98–100%
- 12-month significant cancer-free rate: 79–86%

Functional outcomes:
- Continence preserved: 93–100%
- Sexual function preserved: 75–98%

Common temporary effects:
- Urinary frequency or urgency
- Mild discomfort
- Blood in urine

Less common:
- Urethral stricture (2–3%)
- Erectile changes (15–20%)
- UTI (<5%)

What follow-up schedule should I expect?

Typical schedule:

Timepoint	Assessment
6 weeks	PSA test, recovery review
3 months	PSA test, clinical assessment
6 months	PSA test, possible MRI
12 months	PSA, MRI, possible biopsy
Ongoing	Annual PSA; MRI as needed

Monitoring checks PSA trends, MRI changes, and new symptoms.

Book your consultation View our locations

Learn more about Focal Therapy and Prostate Cancer

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Any questions?

If you've got any questions about your prostate cancer diagnosis or want to know more about your treatment options, don't hesitate to get in touch with our friendly, knowledgeable team.

0207 036 8870

info@thefocaltherapyclinic.co.uk

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Reference List

Ahmed HU et al. (2015). Focal therapy for localised prostate cancer: a systematic review of the literature. Nature Reviews Urology.

Ganzer R, Fritsche HM, Brandtner A, et al. (2017). Five-year outcome of HIFU treatment for localised prostate cancer. Urologia Internationalis.

The Focal Therapy Clinic - Prostate Cancer Treatments (Internal Resource).

NHS Resources on Prostate Cancer (Internal/External Resource).

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Prostate Cancer Treatment Options

Prostate Cancer Treatment Options

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Choosing Between Prostate Cancer Treatment Options

Hear from some of our patients about the effect focal therapy has had on their lives.

Steve’s Story

Dave’s Story

Guy’s Story

Questions to ask your doctor or nurse

Frequently asked questions

Learn more about Focal Therapy and Prostate Cancer

Can Exercise Before Prostate Cancer Treatment Improve Your Recovery?

“Nobody Should Die of This”: Why Elvin Box Is Campaigning for Earlier Prostate Cancer Testing

How Can You Make Sure Focal Therapy Is Discussed at Your MDT Meeting?

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