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.

If the cancer has not spread throughout the entire prostate

New and improved diagnostic techniques have made it possible to identify focal tumours at an early stage and treat them specifically. This means that we are now able to identify tumours confined to a single lesion (unifocal) or a single area, such as a lateral lobe. Tumours identified at a very early stage can also be treated with what is known as focal therapy.

However, focal therapy is only suitable for highly selected patients. The general state of the patient’s health plays an important role and numerous criteria must be carefully considered. The prostate tumour must be limited to just one or very few lesions within the prostate and the Gleason score must 3+4. The PSA level is another criterion, as focal treatment is only an option for patients with a PSA level below 15 ng/ml. It is also an option if you do not wish to undergo surgery or if other health reasons make you an unsuitable candidate for surgery.

Selection of patients for focal therapy

The selection of patients for focal therapy is crucial for the best possible oncological and functional results of the treatment. Therefore it is necessary that the investiga-tions like the MRI and the biopsy are of high quality. The number of cores (minimum 12-15) and long core lengths (minimum 15 mm) are required to evaluate the tumour and its exact extension precisely. In case these are not present, it would be manda-tory to perform a confirmatory biopsy in our institution for a maximum of safety con-cerning treatment planning and implementation.

Accompanies you through this topic

Prof. Dr. Georg Salomon
Faculty member

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.

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.

Prof. Dr. Georg Salomon und Dr. Yamini Nagaraj

Prof. Dr. Georg Salomon and Dr. Yamini Nagaraj

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

HIFU method (Focal One)

Fokal-Therapie mit HIFU-Gerät wir durchgeführt

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.

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

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.

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.