Before the development of focal therapy, men typically had two options to manage their localized prostate cancer:
- Active surveillance – Also known as “watchful waiting”, low-risk patients undergo regular medical tests to determine whether their cancer is getting worse. About half of the men under active surveillance will eventually need to have treatment.
- Radiation or surgery – Although effective at eradicating localized prostate cancer, radiation and surgery each carry a high risk of side effects for urinary, sexual, and bowel functions such as urinary incontinence and erectile dysfunction.
Many men who have low-risk diseases opt for active surveillance until treatment is necessary, as the side effects of radiation and surgery can be permanent and significantly impact the quality of life and mental health. On the other hand, undergoing regular medical tests under active surveillance can also be stressful and unsettling.
Focal therapy offers a middle-ground option with the goal of preserving men’s quality of life by treating a defined region of the prostate containing cancer and leaving other healthy regions of the prostate unaffected.
What is focal therapy for prostate treatment?
Focal therapy for prostate treatment concentrates on cancer that is contained (localized) within the prostate. By treating the “index lesion(s)” (a tumor visible on a diagnostic MRI exam), physicians can avoid damage to surrounding organs and nerves while providing relief and peace of mind for patients.
The main idea of focal therapy is to treat only the prostate regions which contain the index lesion(s). If a defined region of the prostate can be managed safely and precisely, doctors can minimize side effects and preserve urinary, sexual, and bowel functions. When compared to radiation and surgery, focal treatment is less invasive with a shorter recovery time.
Focal therapy treatment options
Instead of treating the entire prostate gland, focal therapy targets the index lesion(s) in a specific prostate area to ablate (destroy) the affected tissue.
Focal therapy treatment options include:
- TULSA-PROCEDURE – A revolutionary method of customizable therapy involving directional ultrasound energy to ablate malignant and benign prostate tissue. The TULSA Procedure is performed under MRI real-time thermal mapping for the most accurate, rapid, and effective ablation therapy. The procedure uses an ‘inside-out’ approach (from inside the urethra heating outwards to the edge of the prostate) to avoid contact with surrounding tissues, organs, and nerves. The TULSA Procedure is well suited for any sized prostate (small to extra large), target tissue anywhere in the prostate (posterior, anterior, lateral) and any number of index lesions (single lesion limited to a small sector or one side of the prostate, to multiple lesions spread across both sides of the prostate).
- Cryotherapy – How cryotherapy works, is that transperineal needles are filled with cold gas and are inserted through the skin and into the prostate, where the gas is released, cooling the surrounding tissue to – 40 °C. Additionally, urethral and rectal warming are used, along with three to four invasive temperature probes to confirm the distal edge of the cryoablation zone.When compared with EBRT, whole-gland cryoablation has a better 8-year biochemical (PSA) failure-free rate, but worse sexual function preservation than EBRT and fairly high rates of permanent urinary incontinence.
- HIFU (High-Intensity Focused Ultrasound) – (High-Intensity Focused Ultrasound) – Uses high-intensity sound waves from an ultrasound probe inserted into the rectum. The thermal ultrasound energy heats and destroys the diseased tissue using discrete, point-form sonications. Unlike the TULSA Procedure, HIFU uses an ‘outside-in’ approach because the ultrasound energy comes from within the rectum, which is located outside the prostate.
- Photodynamic Therapy – This type of therapy uses a drug called a photosensitizer that is injected into the bloodstream. The drug absorbs light rays directed at the tumor, which generates transient levels of reactive oxygen species (ROS).Non-thermal laser fibers are placed transperineally through a template which are used to locally activate the drug, resulting in vascular occlusion and coagulative necrosis. In a randomized trial of 206 patients that underwent Vascular-Targeted Photodynamic Therapy, 49% resulted in a negative biopsy at 24 months post-treatment and approximately 8% experienced Grade 3 adverse events.
- Laser Ablation – Laser energy burns away prostate tissues and can be performed in conjunction with MRI real-time mapping to allow for precise targeting and results. In this therapy, a transperineal or transrectal needle is placed to allow a laser fiber to be pushed into the prostate. The tip of the laser fiber emits light energy into a spherical area that gets absorbed by the prostate tissue, heating it up to a high enough temperature that results in ablation of the tissue.The light intensity is down to about half of the source intensity in the first 2 mm (radius). Beyond that most of the heating is by thermal conduction from the inner heated part. For TULSA-PRO, the point of half the energy being lost is around 20-25 mm.In a small study of 10 patients, they found that 3 out of 10 patients had a negative biopsy at 6 months while the other 7 patients had a Gleason score that was less than or equal to their score at baseline. In those 3 patients with a negative biopsy, they also had an average PSA reduction of 60%
Candidates for focal therapy
Focal therapy was first introduced in 2007 for low-risk patients as an alternative to active surveillance. Today, modern focal therapy treatments have expanded to include patients with intermediate-risk cancer, and, less commonly, certain patients with high-risk disease who meet specific criteria. Good candidates for focal therapy depend on the treatment, prostate gland size, and prostate condition.
If you’re concerned about a prostate-related condition, speak to your doctor about focal therapy and the right treatment option for you. To determine whether you are a candidate for the TULSA Procedure, find a TULSA-PRO center nearest you where you will be referred to a TULSA-PRO® physician who can determine your eligibility.
Sep 1, 2022 | TULSA Procedure