A subsidiary of the University Medical Center Hamburg-Eppendorf

A subsidiary of the University Medical Center Hamburg-Eppendorf

Focal therapy– targeted treatment of prostate cancer

For most patients with localised prostate cancer, the entire prostate must be treated through either complete removal of the prostate (prostatectomy) or radiotherapy. This is necessary because numerous tumour lesions are distributed throughout the entire prostate in over 80% of cases. This is called a multifocal tumour.

What is focal treatment?

Focal treatment does not involve removing the entire prostate. Instead, the treatment focuses on a tumour lesion or the affected lateral lobe of the prostate.

Focal treatment of the prostate is a particularly promising option when focused on a single tumour lesion with a low grade cancer. The smaller the tumour lesion and the less invasive the procedure, the lower the risk that the treatment will result in damage to nerve bundles, the sphincter or the intestinal wall. Consequently, severe and long-term side effects of focal treatment are very rare. The greatest risk lies in the fact that tumour lesions could remain undiscovered and therefore go untreated. However, regular aftercare appointments can identify any growing tumours and treat them if needed.

Martini-Klinik

Accompanies you through this topic

Prof. Dr. Georg Salomon
Faculty member

Martini-Klinik

Careful patient selection for the best results

If you are a candidate for focal therapy based on your tumor situation, our doctors will review your eligibility, recommend the appropriate treatment, and plan the surgical procedure.

At present, the Martini-Klinik offers the HIFU (Focal One) method. This modality is well established and have been thoroughly examined in terms of their efficacy. There are, however, other forms of focal therapy, such as irreversible electroporation (IRE), also known as the NanoKnife system, which is currently being trialled in studies.

Benefits of the treatment

The smaller the tumour lesion and the less invasive the procedure, the lower the risk that the treatment will result in damage to nerve bundles, the sphincter or the intestinal wall. Severe, frequent and long-term side effects are very rare after focal therapy. The greatest risk lies in failing to identify and treat all the cancer lesions. However, regular aftercare appointments can identify these growing tumours and treat them if needed.

HIFU method (Focal One)

Fokal-Therapie mit HIFU-Gerät wir durchgeführt
Fokal-Therapie HIFU-Gerät

Tumours occur most commonly in the peripheral zone. In such cases, the HIFU method is most suitable.

After inserting the rectal probe, the ultrasound images are fused with the images from past MRI scans. This makes it possible to draw up three-dimensional plans of the treatment area. The treatment is computer-assisted and uses the HIFU device. The HIFU waves are focused on a single location, like sunlight shining through a burning lens, and generate temperatures of 85 to 90°C, destroying the cancer tissue with millimetre precision. An external motion sensor, automatic monitoring of the distance to the rectal wall and constant cooling of the rectal wall together ensure precise treatment. The system interrupts the procedure if clearance limits are exceeded.

HIFU method (Focal One)

Outline of the focal treatment process

The treatment is performed on an inpatient basis under general anaesthesia. After the procedure, a catheter is inserted for four to eight days. Patients stay in the clinic for two days. You will be able to walk around again in the evening after the treatment.

Your inpatient stay for focal treatment

Monitoring after focal therapy

  • PSA level measured every three months
  • Control biopsy and MRI after 6 to 12 months
  • MRI scans to monitor long-term progress

We would be happy to advise you during our special consultation clinic on focal treatment. 

Prof. Dr. Salomon [Translate to Englisch:] Prof. Dr. Georg Salomon
Martini Klinik Ärztin [Translate to Englisch:] Dr. Yamini Nagaraj
Martini Klinik Arzt [Translate to Englisch:] Dr. Jonas Ekrutt
[Translate to Englisch:] Jan Lukas Hohenhorst
[Translate to Englisch:] Jan Palec
What is focal treatment for prostate cancer?

For most patients with a localised prostate carcinoma, the entire prostate must be treated through either complete removal of the prostate (prostatectomy) or radiotherapy. This is called a multifocal tumour. Focal treatment does not involve removing the entire prostate. Instead, the treatment focuses on a tumour lesion or the affected lateral lobe of the prostate. Focal treatment of the prostate is a particularly promising option when focused on a single tumour lesion with a low Gleason score. 

Who is focal therapy suitable for?

Focal therapy is particularly suitable for patients with locally confined prostate cancer, in which the tumor areas are limited to a defined region within the prostate. Ideal candidates are those with low- or intermediate-risk tumors (e.g., Gleason score 6 to 7) that show no signs of metastasis. Eligibility is determined through comprehensive diagnostic testing, including mpMRI and biopsy.

What are the advantages of focal therapy over a radical prostatectomy?

Since only a small area is treated, the risk of side effects is significantly lower. The risk of incontinence (urine leakage) and erectile dysfunction (impotence) is much lower, as the nerves and muscles responsible for these functions are largely spared. In addition, the recovery time is shorter. The hospital stay is usually only two days (two nights!).

What are the different types of focal therapy?

The most common procedures are:

  • High-intensity focused ultrasound (HIFU): physical, thermal destruction of the tumor
  • Irreversible electroporation (IRE): the tumor is destroyed by ultrashort high-voltage pulses
  • Cryotherapy: the tumor is destroyed by cold
  • Laser ablation: the tumor is destroyed by a focused laser
  • Focal radiation therapy: Targeted irradiation of only the tumor-affected area
  • Photodynamic therapy: Photoactive substances used to destroy the tumor

The choice of procedure depends on the tumor, the size of the prostate, and the experience of the treating center. At the Martini Clinic, we use HIFU (High-Intensity Focused Ultrasound) as well as Irreversible Electroporation (IRE). These are safe methods with a very strong evidence base from clinical studies.

Focal therapy – how is the appropriate method selected?

After carefully selecting patients based on prostate size and, above all, tumor location, we work together to choose the most appropriate procedure.

How is the success of focal therapy assessed?

Regular follow-up examinations are necessary after treatment:

  • Regular blood tests to monitor the prostate-specific antigen (PSA level). This level should decrease after successful treatment.
  • Imaging: MRI scans can visualize the treated area and detect changes at an early stage.
  • Biopsies: At certain intervals, a repeat tissue sample may be necessary to ensure that no active cancerous tissue remains or develops.
Are there any risks or side effects associated with focal therapy?

As with any medical procedure, focal therapy also carries risks. Possible side effects include pain, minor bleeding, infections, or temporary difficulty urinating.

Can focal therapy completely cure cancer?

Focal therapy can achieve a complete cure in carefully selected patients by selectively destroying the tumor. Nevertheless, prostate cancer is a condition that requires long-term monitoring, as there is always a residual risk of recurrence or new tumor foci. Follow-up care is therefore very important.

How long does the treatment and recovery period last for focal therapy?

The procedure itself takes only about an hour, and the hospital stay is usually two days. The recovery time is significantly shorter than that required for radical procedures. Many patients can resume their normal activities after just a few days, although strenuous physical activity should be avoided for several weeks.

Is focal therapy covered by health insurance?

Health insurance coverage varies, and coverage is not always guaranteed. It is important to clarify coverage with your health insurance provider in advance and, if necessary, submit a claim for reimbursement.

If necessary, can I receive further treatment after focal therapy?

Yes, if the cancer is not completely treated or recurs, further treatments are possible. In addition to repeat focal therapy, a radical prostatectomy, radiation therapy, or hormone therapy may be indicated. Focal therapy therefore does not preclude subsequent treatment options.