An emerging no-invasive surgical alternative shows promise for treating prostate cancer

Studies have revealed an emerging non-invasive surgical alternative for patients with localized prostate cancer. It is called focal therapy, and it attacks malignant cells, leaving healthy tissue intact.

The goal of this procedure is to remove “clinically significant” tumor tissue, i.e., cancer that would eventually spread if left untreated.

Although there is always a risk of recurrence, focal therapy reduces the risk of erectile dysfunction and urinary incontinence. These are the most frequent potential side effects of radical prostatectomy, which removes the entire prostate and some of the surrounding tissue, such as the lymph nodes, or the seminal vesicles that help produce semen.

A study following the localized prostate cancer status of about 1,400 men, half of whom had radical prostatectomy and half of whom had focal therapy, showed similar health outcomes five years after the procedures.

This therapy began to be used in 2007, but only as an alternative to active surveillance in very low-risk patients. Since then, the use of focal therapy has been expanded to include people with favorable intermediate-risk disease, as defined by the guidelines of the National Comprehensive Cancer Network. 

The best candidates have a prostate of about 40cc in size or a tumor in the lower half of a larger gland, a single visible tumor on MRI, and the absence of cancer elsewhere in the gland (as shown by biopsies).

The techniques to perform focal therapy for prostate cancer are:

Cryotherapy. This uses cold gas that is introduced into the prostate through needles, which freezes and destroys cancer tissue.

High Intensity Focused Ultrasound (HIFU). This technique uses high-frequency sound waves directed at the tumor through an ultrasound probe that is inserted into the rectum. These waves cause the diseased tissue to heat up and die.

Photodynamic therapy. This technique uses a photosensitizer drug that is injected into the bloodstream. This medication absorbs light rays directed at the tumor and produces an active form of oxygen that destroys the cancer cells.

Laser ablation. This uses laser radiation energy applied to a very small area to burn away cancerous tissue. Some forms of laser ablation have the advantage of being able to be performed at the same time as magnetic resonance imaging (MRI), which allows for very specific targeting and real-time views of results.

In each case, the doctor will consider the patient’s overall health and mental state, the size and location of the tumors present, and their chances of spreading more. The use of tests such as MRI, ultrasound, and biopsy (tissue samples examined in the lab) can help decide if the patient will benefit more from focal therapy or from traditional treatments.

Patients treated with focal therapy still need active monitoring afterwards. This includes looking out for disease that may be undetected, has returned, is spreading, or is appearing for the first time. If follow-up tests show that some of the treated cancer still remains, additional ablation, surgery, or radiation may be required.

This story was produced using content from original studies or reports and from other medical research, as well as health and public health sources, highlighted in related links throughout the article.