Paul Gellhaus, MD, is a urologic oncologist, medical director of Robotic Surgery, and an associate clinical professor in the Department of Surgery at City of Hope Cancer Center Phoenix

Dr Gellhaus on the Advantages and Limitations of Focal Therapy for Prostate Cancer

"The more we can do these partial, less invasive maneuvers, the less the patient has to give up to get those benefits. With screening, we need to detect these cancers at a lower stage and a smaller volume so that these focal therapies have a better chance of working."

Paul Gellhaus, MD, a urologic Oncologist and medical director of Robotic Surgery, as well as an associate clinical professor in the Department of Surgery at City of Hope Cancer Center Phoenix, detailed some of the benefits and limitations of focal therapy for patients with prostate cancer, as well as potential avenues for improving the effective use of this technology.

Gellhaus began by stating that focal therapy is a "very exciting field" because it allows clinicians to treat the cancer without incurring all the adverse effects typically associated with whole-gland radiation or surgery. Focal therapy methods are diverse, employing various energy sources, such as freezing, burning, or electroporation (lysing cells using a strong magnet). Other areas of development include light therapy and even surgical techniques designed to partially remove the gland.

However, there are several limitations associated with effective implementation of focal therapy primarily because prostate cancer is often multifocal, Gellhaus acknowledged. Although some multifocality may represent clinically insignificant, lower-grade disease, it complicates treatment planning. An additional challenge arises because the imaging used to guide therapy can be discrepant from the actual histopathology, he explained. Therefore, clinicians must rely on MRI and hope to accurately target the cancer based on imaging, despite the differences between expected biology and the geometry of the prostate, Gellhaus said.

Gellhaus suggested that improving imaging techniques is crucial, as increased accuracy in diagnosis would, in turn, lead to greater accuracy when delivering a focal removal or ablation of the tissue. He emphasized that surgery dramatically and permanently alters the anatomy of the pelvis, often resulting in a loss of urinary and sexual function. Therefore, performing partial, less invasive maneuvers, such as focal therapy, means the patient sacrifices less to achieve therapeutic benefit. Ultimately, for focal therapies to be most effective, Gellhaus stressed the need for screening to detect these cancers at a lower stage and a smaller volume. If the tumor is more advanced, a more extensive treatment like surgery may be required to entirely remove the cancerous tissue, he concluded.

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Paul Gellhaus, MD, discusses ongoing developments with focal therapy in prostate cancer and potential avenues for technological improvement.

Dr Gellhaus on the Significance of Prostate Cancer Awareness Month 

“Prostate cancer is...such an important disease because of how common it is. We want to make sure we’re diagnosing the right people, and [that] we’re treating the right people and not overdoing [treatment] and causing the burden of repeated unnecessary steps and unnecessary diagnosis and evaluation alongside treatment."

Paul Gellhaus, MD, a urologic oncologist, medical director of Robotic Surgery, and an associate clinical professor in the Department of Surgery at City of Hope Cancer Center Phoenix, discussed the value of prostate cancer screening in the context of Prostate Cancer Awareness Month, which is observed annually in September.

Prostate cancer represents one of the most common malignancies among men, with data indicating that approximately 1 in 6 to 1 in 8 men will develop the disease during their lifetime, Gellhaus began. Because of its high prevalence, prostate cancer affects individual patients, as well as their families and caregivers, he stated. Given this widespread burden, the establishment of accurate, evidence-based strategies for diagnosis and management remains essential, he said. The clinical challenge lies in balancing the early identification of clinically significant disease and avoiding unnecessary interventions that may expose patients to additional burdens, both physical and psychological, associated with overdiagnosis and overtreatment, he emphasized.

Screening for prostate cancer has been a controversial issue, according to Gellhaus. Guidelines have historically varied, often shifting between supporting and discouraging screening, which has created considerable uncertainty for both patients and physicians, he reported. Primary care providers in particular often experience challenges in interpreting and applying these evolving recommendations, especially given their already demanding clinical responsibilities, he explained.

The use of prostate-specific antigen (PSA) testing has been central to the screening debate, Gellhaus noted. Although concerns have been raised regarding unnecessary testing and follow-up procedures, declining use of PSA screening has coincided with an observed increase in patients presenting with advanced-stage disease, he continued. This trend underscores one of the limitations of reducing screening efforts, as the absence of early detection frequently results in disease progression to stages that are more difficult to manage effectively, he added.

A significant barrier to optimal screening has been the spread of misinformation regarding the utility of PSA testing and prostate cancer screening in general, Gellhaus contextualized. Recent advances in diagnostic technologies, however, have improved the accuracy of cancer detection and provided oncologists with better tools to distinguish patients who are most likely to benefit from intervention, he highlighted. These developments have enhanced detection and improved risk stratification, allowing oncologists to better determine which patients require active treatment and which may be safely monitored, he concluded.

Paul Gellhaus, MD, discusses the clinical implications of prostate cancer screening in recognition of Prostate Cancer Awareness Month.

Paul Gellhaus, MD

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Dr Gellhaus on the Advantages and Limitations of Focal Therapy for Prostate Cancer

Dr Gellhaus on the Significance of Prostate Cancer Awareness Month