Focal Therapy for Prostate Cancer

Not every man with prostate cancer is suitable for focal therapy. Before recommending treatment, your consultant will assess the location, size and grade of your cancer, along with your overall health and prostate anatomy.

Focal therapy may be appropriate if:

• you have localised prostate cancer which is confined to the prostate

• there are 1 or 2 clearly identifiable tumour areas

• you have intermediate-risk prostate cancer, including Gleason 3+4=7 or 4+3=7 (ISUP Grade Group 2 or 3)

• you have high-risk disease that remains confined to the prostate

• there’s no evidence that the cancer has spread to other areas of the body

• the cancer has recurred after previous radiotherapy

Your assessment may include:

• multiparametric magnetic resonance imaging (mpMRI)

• targeted transperineal prostate biopsy

• prostate-specific antigen (PSA) blood testing

• assessment of prostate size and anatomy

• imaging to confirm there are no distant metastases

Men with extensive cancer, multifocal cancer, or cancer that has spread beyond the prostate capsule are usually better suited to whole-gland treatments, such as surgery or radiotherapy. Your consultant will explain all suitable treatment options and help you make an informed decision.

Focal therapy is performed as a day-case procedure at Welbeck, meaning you will return home on the same day as treatment.

The procedure is carried out in an operating theatre in our Surgery Centre under general anaesthetic. The exact technique used depends on the position of the tumour, the anatomy of your prostate and which treatment is most suitable for you.

Before treatment, your consultant will review your scans, biopsy results and treatment plan in detail. They will explain the procedure, discuss the benefits and risks, and answer any questions you may have.

At Welbeck, we offer three established focal therapy techniques:

High Intensity Focused Ultrasound (HIFU)

High Intensity Focused Ultrasound (HIFU) uses concentrated ultrasound energy to heat and destroy prostate cancer cells with a very high degree of precision.

The ultrasound energy is focused onto a tiny point within the prostate, raising the temperature to approximately 65°C to 90°C, which destroys the cancer cells while minimising damage to surrounding healthy tissue.

During the procedure:

• you receive a general anaesthetic

• a specialised ultrasound probe is placed into the rectum. There are no cuts to the skin

• real-time ultrasound imaging guides treatment throughout the procedure

• only the identified cancer is treated

The procedure usually takes 1.5 to 2.5 hours, and you can normally return home later the same day.

Focal cryotherapy

Focal cryotherapy destroys cancer cells by freezing them.

During treatment, your consultant inserts very fine needles through the skin between the scrotum and anus (the perineum) using ultrasound guidance. The treatment area is then frozen to temperatures between -40°C and -100°C, destroying cancer cells while carefully avoiding nearby healthy structures.

Cryotherapy can be particularly helpful for tumours located towards the front of the prostate or where HIFU may not be technically suitable because of the shape of the gland.

The procedure takes around 1.5 to 2.5 hours and is performed under general or spinal anaesthetic as a day-case procedure.

NanoKnife (irreversible electroporation)

NanoKnife, also known as irreversible electroporation (IRE), uses short electrical pulses rather than heat or freezing to destroy cancer cells.

Several fine needles are placed into the prostate under imaging guidance. Controlled electrical pulses create tiny openings in the cancer cells, causing them to die while helping preserve surrounding connective tissue.

NanoKnife may be recommended when a tumour lies very close to important structures, such as:

• the nerves responsible for erections

• the urethra

• other sensitive areas where heat or freezing may carry a higher risk of side effects

Your consultant will advise whether NanoKnife is the most appropriate treatment based on the location of your cancer and your prostate anatomy.

Compared with radical surgery or radiotherapy, focal therapy has substantially lower rates of permanent urinary incontinence, erectile dysfunction, and bowel complications because much of the healthy prostate and surrounding structures are preserved.Your surgeon will explain the risks to your individual features.

National UK registry data also show that cancer control following focal therapy is comparable with radical treatments in appropriately selected patients. Around 20% to 30% of men may require a second focal treatment to the same area as part of their planned treatment pathway, while only 5% to 10% ultimately require whole-gland surgery or radiotherapy over a ten year follow-up period. Cancer specific survival over ten years is 99.9%.

Focal therapy is designed to reduce the risk of long-term side effects by treating only the cancer rather than the whole prostate. However, as with any medical procedure, complications can occur.

Possible risks include:

• temporary urinary frequency and urgency

• discomfort or burning when passing urine

• mild bleeding or tissue debris in the urine during healing

• fatigue for several weeks

• urinary infection

• temporary catheter dependence

• narrowing of the urethra (urethral stricture), which is uncommon

• erectile dysfunction, although the risk is generally lower than with whole-gland treatments

• urinary incontinence, which is uncommon

• bowel injury, which is very rare

Before your procedure, you'll attend a consultation with one of our consultant urologists. They will review your prostate cancer diagnosis, discuss whether focal therapy is the most appropriate treatment for you, and explain the procedure, including its benefits, risks and expected outcomes.

To plan your treatment accurately, you'll usually need:

• a multiparametric magnetic resonance imaging (mpMRI) scan

• a targeted transperineal prostate biopsy

• prostate-specific antigen (PSA) blood tests

• any additional investigations needed to confirm that the cancer is confined to the prostate

As focal therapy is performed under general or spinal anaesthetic, your consultant will provide instructions about fasting before your procedure. They’ll also advise whether you need to stop or continue taking any regular medications, particularly blood-thinning medicines.

Because you'll be having an anaesthetic, you should arrange for a family member or friend to take you home after your procedure. It is not safe to drive yourself.

Most patients return home on the same day as their treatment.

Following focal therapy, a urinary catheter is usually left in place for 7 to 9 days to allow the treated area to heal. Your consultant or specialist nursing team will arrange an appointment to remove the catheter, usually between 7 and 14 days after your procedure.

It's normal to experience some temporary side effects while your prostate heals. These may include:

• urinary frequency

• urinary urgency

• mild discomfort when passing urine

• small amounts of blood or tissue debris in your urine

• tiredness for several weeks

These symptoms usually improve gradually over 6 to 8 weeks.

Most people can:

• return to desk-based work after around 2 to 3 weeks

• resume more strenuous exercise and heavy lifting after 4 to 6 weeks, depending on their recovery and their consultant's advice

Follow-up after focal therapy

Follow-up is an important part of focal therapy because it allows your consultant to monitor your recovery and assess how well the treatment has controlled the cancer.

Your follow-up schedule typically includes:

• catheter removal after 7 to 14 days

• a PSA blood test at 3 months

• a follow-up consultation at 3 months to discuss your recovery and PSA results

• a repeat MRI scan and PSA blood test at 12 months

• PSA monitoring every 6 months after a clear 12-month MRI, together with annual reviews

If your PSA rises consistently, your consultant may recommend further investigations, including another MRI scan and, if needed, a targeted biopsy.

It's important to remember that PSA levels can fluctuate after focal therapy. A temporary rise does not necessarily mean the cancer has returned, and your consultant will explain what your results mean throughout your follow-up care.

Please contact our Urology centre for pricing information.

At Welbeck, our urology specialists are international experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

To book focal therapy for prostate cancer, you must be referred by either your GP or a consultant following a consultation with them. Self-referrals are not accepted for this treatment.

If you would like to schedule a consultation with one of our consultant urologists, please get in touch to make an appointment. Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.