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.