What is focal therapy in the treatment of prostate cancer?

Marc B. Garnick, MD
Hematology & Oncology
Focal therapy for prostate cancer similar to a “lumpectomy” in the treatment of women with breast cancer – where only the cancerous tissue is targeted for treatment.

Two teams of researchers, one in England and the other in the United States, have published papers arguing in favor of testing focal therapy (targeted therapy), in which only the tumor and a small margin of normal tissue around it are treated instead of the entire prostate gland. This approach, they say, would minimize damage to structures essential for sexual, urinary, and bowel function and allow for retreatment later on if necessary.

To support their thinking, the U.S. team pointed to a study showing that 38% of prostate tissue samples analyzed after radical surgery had a single cancerous lesion. In patients with multiple disease sites, or foci, 80% of the total tumor volume could be attributed to the largest cancerous spot, according to another study. Because the secondary tumors rarely have higher Gleason scores than the main tumor, the thinking goes that they are unlikely to affect overall disease progression. As a result, the researchers suggest targeting just the primary tumor (what doctors call the index tumor). Because they can reliably target a specific point, cryotherapy (which kills cancer cells by freezing them), high-intensity focused ultrasound (HIFU), and radiation therapy can be used as focal therapies (also called ablative therapies) to attack the primary tumor. Photodynamic therapy (PDT), which has been used to treat skin cancer, also shows potential as a focal therapy for the treatment of prostate cancer. In addition, the use of electrical currents can be applied to the cancers that are located in the prostate. This is called electroporation. All of these methods are investigational and have not undergone rigorous comparisons to more established methods. For a man to undergo focal therapy, he must first have a “mapping biopsy,” in which up to 100 biopsies of his prostate gland are taken under general anesthesia, and each sample is then mapped to the location of the gland. This mapping allows treatment of the cancerous tissues by one of the ablative therapies listed above.

Since focal therapy does not treat the entire prostate, consistently finding and hitting the target area is essential.
Focal therapy is a general term for a variety of techniques for destroying small tumors inside the prostate. In this video, Simon Hall, MD, chair of the Urology Department at The Mount Sinai Medical Center, discusses focal therapy options.

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