When your doctor tells you or a loved one has prostate cancer, it's normal to feel scared, anxious, and uncertain. "What do I do now? Will I have to have major surgery? Will there be side effects?" You may have many questions running through your mind. But don't worry. Medical science has advanced a lot today. Not all cancers are treated the same way. Today, we're going to talk about a new treatment for prostate cancer that is different from traditional surgery and radiation therapy, and has fewer side effects. That's called 'Focal Therapy.'
What is Focal Therapy, simply put?
Simply put, Focal Therapy is a treatment method that targets only the specific location of the cancer and destroys the cancer cells, without treating the entire prostate gland.
Think of your prostate gland as an orange. The cancer is only in a small part of one side of the orange. In the past, in cases like this, the entire orange, that is, the entire prostate gland, had to be removed surgically (whole-gland surgery) or the entire gland had to be given radiation therapy. But doing so can also damage healthy parts of the prostate that are not cancerous. That increases the risk of side effects like urinary incontinence and sexual dysfunction.
But in Focal Therapy, what happens is that the cancer is targeted only at the specific location and an energy source such as heat, cold, or electric shock is used to destroy only those cancer cells. It's like taking a small spot on a leaf and holding a sunglass and burning only that spot and removing it. This causes very little damage to healthy tissue.
This can be considered a good intermediate option between waiting without any treatment (Active Surveillance) and treating the entire gland (surgery/radiation).
What are the different types of this treatment?
There are several different techniques for performing Focal Therapy. Your doctor will determine which method is right for you. The table below lists some of the most commonly used techniques.
| Type of Therapy | How it Works |
|---|---|
| Cryotherapy | Using special gases, cancer cells are destroyed by freezing them (petrifying them). |
| Focal Laser Ablation (FLA) | The intense heat generated by laser rays is used to burn away cancer cells. |
| High-Intensity Focused Ultrasound (HIFU) | The heat energy from high-frequency sound waves (ultrasound) destroys cancer cells. |
| Irreversible Electroporation (IRE) | Electrodes are placed around the cancer and an electric current is passed through them, damaging and destroying the membranes of the cancer cells. |
| Transurethral Ultrasound Ablation (TULSA) | A device is inserted through the urethra and uses sound waves to generate heat and destroy cancer cells. |
Who is Focal Therapy best suited for?
This is a very important question. Because this treatment is not for everyone. Your doctor will carefully examine your condition and decide whether you are suitable for this or not. Generally, those who are eligible for this treatment are:
- People whose cancer is limited to the prostate gland (localized): This method is not suitable if the cancer has spread to tissues outside the gland or to other organs.
- People with intermediate-risk: If the cancer is very aggressive and spreads quickly (high-risk), treatment (surgery/radiation) of the entire gland is safer.
- The cancer is located in one place in the gland: If the cancer has spread throughout the gland, this method will not be successful.
- The cancer is not located near the urinary sphincter or urethra: If it is nearby, treatment may damage those parts.
For people with very low-risk cancers, active surveillance, often without any treatment, may be sufficient.
What tests should be done before treatment?
Before performing Focal Therapy, the exact location, size, and boundaries of the cancer need to be determined. This requires several tests, such as:
- MRI (Magnetic Resonance Imaging) scan: This helps to find the exact location of the cancer by taking very clear pictures of the prostate gland.
- MRI-guided prostate biopsy: A piece of tissue is taken from the suspicious area seen on the MRI and examined.
- Mapping Biopsy: Several tissue samples are taken from different parts of the gland to determine the exact boundaries of the cancer.
- PSMA PET scan: This test is important to confirm whether the cancer has spread to other areas outside the prostate gland.
What are the advantages and disadvantages of this treatment?
Like any medical treatment, Focal Therapy has both advantages and disadvantages. It is important to be aware of both sides before making a decision.
| ✅ Advantages | ❌ Disadvantages |
|---|---|
| The damage to healthy tissue is minimal. | It may not be possible to eliminate all cancer cells. |
| The risk of side effects such as sexual dysfunction and urinary incontinence is low. | The risk of cancer recurrence is higher with surgery. |
| There is an opportunity to avoid invasive treatments such as major surgery and radiation therapy. | If the cancer recurs, other treatments (surgery/radiation) will be required. |
| Being a more active treatment than "doing nothing and waiting" (Active Surveillance). | Because these are very new treatments, there is not yet complete data on long-term outcomes. |
| The recovery time after treatment is short. | After treatment, you should be closely monitored with regular tests such as MRI and biopsy. |
What happens after treatment?
It's not all over when treatment is over. The real hard part begins after that. Your doctor will monitor you closely for months, maybe years. Here,
- Are there any cancer cells left that were not affected by the treatment?
- Is there a cancer that has not been completely destroyed by treatment?
- Has the cancer recurred?
- Does cancer spread to other places (metastasis)?
You will be monitored regularly. This may include repeat PSA blood tests, MRI scans, and possibly even a biopsy. If it is confirmed that the cancer is still in your body, you may need to undergo other treatments, such as surgery or radiation therapy.
Take-Home Message
- Focal Therapy is a modern treatment method that targets only the location of prostate cancer and has fewer side effects.
- This treatment is not suitable for everyone. It is best suited for moderate-risk patients whose cancer is confined to the gland.
- Although it has fewer side effects than surgery and radiation therapy, the risk of cancer recurrence is slightly higher. Therefore, close medical monitoring is essential after treatment.
- Only your doctor can make the best decision about whether this treatment is right for you and what its pros and cons are. So, don't be afraid to openly discuss all your concerns with him and make the best decision.
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