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Friday, 07 August 2026 20:32
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Friday, 07 August 2026 20:25
HIFU is the only non-invasive modality currently applied for focal prostate therapy.
Reported functional outcomes are generally favorable, with
continence preservation rates above 90% and erectile function maintained in 70–100% of patients, with the highest rates
observed for non-thermal mechanisms (15, 16) (Tables 1, 2).
Except for HIFU, most techniques are applied via the transperineal route under TRUS guidance, with careful preservation of critical structures such as the urethra, neurovascular bundles, sphincter, and rectum.
The most extensively evaluated techniques include HIFU,
cryotherapy, IRE, vascular-targeted photodynamic therapy
(VTP), and interstitial laser therapy (ILT).
Recent evidence indicates that extending the ablation zone by
10mm beyond the visible lesion captures most clinically significant cancer foci, emphasizing the value of perilesional biopsies during fusion-guided biopsy
(11).
For some people, focal therapy is a good choice instead of radical treatments that target the
whole prostate. Focal therapy works best for small tumors, not for cancer that has spread.
But it’s not an option for everyone — focal therapies haven’t
been studied as much as traditional treatments and some are still considered
investigational. It can also be a more proactive approach than active surveillance for some prostate cancers.
It can provide a less invasive alternative to radiation and surgery and might cause fewer side effects.
Some people get infections in their urinary system or pain in their testicles.
Focal therapy can reduce side effects, such as urinary, bowel,
and sexual problems. We train surgeons in the United States and other countries to learn these precise methods.
After focal therapy for prostate cancer, we’ll also
continue to monitor you through active surveillance.
Any product that may be evaluated in this article, or claim that
may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their
affiliated organizations, or those of the publisher, the editors and the reviewers.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts
have been made to ensure accuracy, including review by the authors wherever possible.
The authors have received funding from Recordati Laboratories to conduct this review;
however, this has not influenced the objectivity and integrity of the article.
The author(s) declare financial support was received for the research and/or publication of this article.
The integration of androgen deprivation therapy (ADT) with focal techniques represents
a promising strategy to expand treatment indications, particularly for higher-risk or
anatomically challenging cases. Multiparametric MRI combined with fusion biopsy is essential for
accurate patient selection, precise targeting, and effective follow-up in focal therapy for prostate cancer.
After 2 years, most of the people in the study had no signs of prostate cancer.
The NanoKnife then passes an electrical current between the electrodes, right through the tumor.
This helps us focus the current right around the tumor while keeping nearby healthy tissue safe.
They check for anything that can affect your procedure.
Most often, you’ll get anesthesia (medicine to make you sleep) before
your procedure.
In practice, many specialized cancer centers offer focal therapy to
carefully selected patients, and thousands of men have been treated with it
worldwide. This flexibility is one of the approach’s advantages, but it also means some patients end up receiving two treatments instead of one definitive intervention. Improvements in MRI and
targeted biopsy techniques have made tumor mapping more accurate, but
no imaging method catches every focus of cancer.
Imaging (typically MRI) is recommended at six months, one year,
and then annually through five years. PSA blood tests start three months after treatment, then continue every three months through the first year and every six months
after that. The closer the ablation zone is to the nerve bundles that run along each side of the prostate,
the higher the risk to sexual function. Studies of focal cryotherapy specifically reported erectile function preservation in 68% to 93% of patients, while focal HIFU showed impotence
rates of roughly 15%.
Interstitial laser therapy (ILT) delivers thermal energy
under MRI thermometry guidance to induce precise coagulative necrosis
(980 nm diode lasers inserted transperineally or transrectally to deliver thermal energy).
Studies indicate that integrating mpMRI into procedure planning enhances tumor control
and maximizes functional preservation, particularly
for modalities such as VTP and HIFU, where treatment precision directly impacts both oncological and functional
outcomes. Optimizing outcomes in focal therapy relies heavily on precise lesion localization and treatment planning using
advanced imaging. Precise electrode placement, guided by MRI or ultrasound fusion, is
essential, and long-term oncological data remain limited (17, 18).
Patients with preserved baseline urinary and sexual function benefit most from IRE’s functional
preservation. Clinical experience is extensive, but oncological control data remain limited, with ablation success
around 90% (15, 16).
Across systematic reviews, 54% to 100% of patients maintained erections sufficient for intercourse after focal therapy, with or
without medication. Urinary incontinence of any kind occurs in only 0% to 5% of patients, and when it
does happen, recovery typically takes just a few weeks.
Tumors located at the apex (the bottom tip of the prostate) or in the anterior (front) portion can be technically difficult to reach with current tools.
There should be no evidence of cancer extending beyond the prostate capsule or into the seminal vesicles.
The procedure is typically performed as a one-to-two-hour outpatient visit under general anesthesia.
Supports 97% pad-free continence at 2-3 years post-HIFU, aligning with the article’s figures.
Side effects are significantly lower, and most complications
are mild or temporary. For the right patients, it is both safe and well tolerated.
Some patients may need a repeat focal therapy session over time, but
many avoid radical treatment entirely. Radiation can work well but often comes with
gradual side effects that build over time. For many men with localised prostate cancer,
the 5-10 year data supports focal therapy as a treatment that controls cancer while preserving quality of life.
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