PCRI’s Executive Director, Mark Scholz, MD, discusses the use of focal therapy for men with prostate cancer. He elaborates on the pros and cons of the different focal treatments and compares them with radical whole-gland treatment.
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0:48 Why choose focal therapy? The main reason is that side effects tend to be substantially lower.
1:24 Types of focal therapy: Focal radiation, seed implant or SBRT, laser treatments, cryotherapy, HIFU, and radiofrequency ablation are all types of focal treatments. Each uses a different method to ablate (destroy) prostate tissue.
1:56 Factors that can affect your focal therapy choice: The experience of the doctor is extremely important, perhaps more so than the actual method itself, but there are significant differences between the different treatments. Cryotherapy, for example, uses liquid argon in a probe to freeze the gland, circulates warm water, in two cycles. Since tissue resists freezing, the transition between frozen and nonfrozen tissue is gradual. Compared with a treatment like laser ablation, this transition zone is very distinct. So with cryotherapy, more of the gland must be frozen to ensure that all the cancer is treated. Whereas with laser, there is the potential for less of a margin to be necessary. This doesn’t necessarily correlate to better cure rates, it's just an example of how different treatments have different challenges. None have been proven to be superior to any other form of focal therapy.
3:35 Should consider focal therapy? Not all patients are eligible for focal therapy, such as patients with large or bilateral tumors (tumors that are on both sides of the gland). Additionally, the tumor must be easily seen on imaging scans to provide a viable target.
4:47 Drawbacks of focal therapy: It’s a new form of treatment and many doctors who are offering it don’t have enough experience to ensure good results. Many focal treatments are not covered by insurance, whereas other stander prostate cancer treatments are fully covered. Since a part of the gland is left untreated, they will have to be on active surveillance.
5:55 Conclusion. There is a concern that cure rates would be lower with focal therapy simply because it doesn’t treat the whole gland, but with good imaging and a generous margin, cure rates should be comparable to standard types of treatment, with the benefit of significantly lower side effects. Focal therapy will be a more popular type of treatment in the future.
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