New research published in European Urology offers encouraging insights into focal therapy as a treatment option for localised prostate cancer. The study, which analysed data from 3,477 patients in the UK, suggests that these less invasive techniques, using either high-intensity focused ultrasound (HIFU) or cryotherapy, are safe and can provide effective long-term cancer control for carefully selected individuals.
Focal therapy aims to destroy only the cancerous tissue within the prostate, preserving the surrounding healthy tissue. This approach is hoped to reduce the side effects often associated with more radical treatments like surgical removal of the prostate (prostatectomy) or radiotherapy. The study, drawing from the prospective HEAT and ICE registries, tracked patient outcomes over an extended period, providing valuable real-world data on this evolving treatment.
While the findings are promising, experts urge caution in their interpretation. Dr Alastair Lamb, Clinical Reader at Barts Cancer Institute, highlighted that while the registry study demonstrates the safety of focal therapy, it does not directly prove its efficacy compared to standard radical treatments, which have been rigorously tested in randomised controlled trials (RCTs) for long-term survival. He emphasised that focal therapy may not be a definitive cure but could become an integral part of future prostate cancer management.
Professor Prabhakar Rajan, Professor of Urology and Robotic Surgery at Barts Cancer Institute, acknowledged the study's contribution to the growing evidence base for focal therapy, particularly its encouraging 10-year cancer outcomes. However, he noted that as an observational registry study, it cannot be directly compared with outcomes from surgery, radiotherapy, or active surveillance. Professor Rajan also pointed out that approximately one-third of patients required further treatment within 10 years, suggesting focal therapy is often part of an ongoing treatment pathway rather than a singular solution.
Crucially, the study did not report on long-term urinary, sexual, or bowel function. As preserving quality of life is a primary driver for patients choosing focal therapy, understanding these functional outcomes is considered just as vital as cancer control. Both Dr Lamb and Professor Rajan stressed the urgent need for high-quality randomised controlled trials, such as the ongoing PART trial, to comprehensively evaluate focal therapy's role alongside established options, considering cancer control, quality of life, and cost-effectiveness for the NHS.