Focal Therapy Evolves Into More Precise Treatment in Prostate Cancer

Brian J. Miles, MD; F. Nery Flores, MD; and Kenneth M. Kernen, MD
Published: Wednesday, Dec 12, 2018
Brian J. Miles, MD

Brian J. Miles, MD

For more than a generation, the notion of lumpectomy instead of radical mastectomy for breast cancer was met with scorn and treated as heresy. Now, it is the standard of care and has saved the physical QoL for many women. Prostate cancer (PCa), which is similar to breast cancer in many ways, has also been considered not amenable to focal therapy as a form of lumpectomy. This is because of the size of the prostate, its relative inaccessibility, the fact that PCa is often multifocal, and concerns that focal therapy may rule out some treatment options if the cancer recurs. However, with the recent FDA clearance of high-intensity focused ultrasound (HIFU) in prostate disease, this therapeutic option has become viable. HIFU has been used for decades in Europe with excellent oncologic control and acceptable AEs.

During the procedure the device’s proximity to the rectal wall is constantly monitored for patient safety. The robotic HIFU device automatically readjusts itself and, if necessary, stops transmission of the high-frequency waves anytime they are too close to the rectal wall. This aids in avoiding rectal injury.

Figure 1. German Study: Survival Rates for Patients With Localized PCa Treated With HIFU1

Figure 1

Long-Term Outcomes

Future long-term studies are hoped to provide data needed to fully analyze the potential of focal HIFU therapy as an alternative to radiation and radical prostatectomy for treatment of localized PCa in the United States. European researchers have published positive peer-reviewed studies of the use of this technology for whole gland ablation.
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