Focal Therapy

Focal therapy implies just treating the focus of cancer within the prostate, not the whole prostate gland. Whilst this concept if favourable from a quality-of-life point of view, there are no long-term studies beyond 15 years regarding progression and functional outcome after focal therapy.  It is also well known that prostate cancer is a multifocal tumour and there would be a risk of the requirement for subsequent whole gland or salvage therapy.

I commenced a NanoKnife focal therapy program with IRE (irreversible electroporation) with my colleagues at the Wesley Hospital in August 2018.  Based on the early data available from our centre there is a ~87.5% infield complete clearance of tumour from the NanoKnife treatment zone. As prostate cancer is commonly a multifocal malignancy, long term surveillance of the remainder of the prostate outside the field of treatment would be required after the IRE therapy, with surveillance prostate biopsies, MRI scans and regular PSA levels. In general terms three of every 10 patients will require salvage whole gland treatment for local progression within 8-10 years of focal therapy.

The benefit of focal therapy includes a short overnight stay, a lower risk of impotence and incontinence of urine compared to a radical prostatectomy or radiotherapy for primary treatment of prostate cancer. There is a risk of retrograde ejaculation or loss of ejaculate (~25-30%), but the risk of rectal injury requiring a diverting colostomy is very uncommon.