Focal Therapy
Focal therapy involves treating only the part of the prostate that contains the cancer, usually as seen on a prostate MRI. This spares the rest of the prostate, including in most cases the parts of the prostate adjacent to structures critical to urinary and sexual function. This substantially reduces the side effects associated with other whole gland prostate cancer therapies.
2 Minute ReadThere are multiple different focal therapies to consider.
High intensity focused ultrasound – HIFU
HIFU involves a high-intensity ultrasound that is many times more powerful than a regular diagnostic ultrasound. It generates heat in the tissues in a very precise location. This allows your doctor to create a boundary around the cancer and kill with heat that entire area. It raises the tissue temperature to greater than 60 degree Celsius, which causes cells in the region to die. HIFU is best for posterior tumors of the prostate, which is a location where tumors frequently occur. HIFU can be used for both an initial prostate cancer therapy and for patients with recurrence after radiation therapy.
Cryoablation
With cryoablation, your doctor will insert a probe through the skin into the prostate to freeze the tissue surrounding the probe. The probes use extremely cold argon gas infused into the tissue. Your doctor will also use a transrectal ultrasound to visualize an ice ball that forms as the tissue around the probe freezes. Your care team will use a urethral warming catheter to prevent damage to your urethra. This therapy is best for tumors of the anterior part of the prostate. Doctors often use this therapy for cancers that come back after radiation therapy, however it is also an option for some people as their initial treatment.
Irreversible electroporation – IRE
In irreversible electroporation, the cancerous area is surrounded by small electrodes inserted through the skin. Once the proper location of electrodes is confirmed on transrectal ultrasound, electrical currents are passed between them. A sufficient level of current creates pores in the cell membranes. If the pores are large enough, the cell can’t repair them, which means all those cells will eventually die and be reabsorbed by the body. One advantage of IRE is that it doesn’t generate any heat or cold. There is some evidence that disruption to local tissue around the tumors is substantially less because of this athermal effect. IRE is best for patients with anterior tumors.
