Dr Olivares on the Use of Focal Therapy in Localized Prostate Cancer

Ruben Olivares, MD, urologic surgeon, associate professor, Urology, Glickman Urological Institute, Cleveland Clinic, discusses the evolving role of focal radiation therapy in the management of localized prostate cancer, highlighting its optimal use according to risk factors and patient characteristics.

By precisely targeting and ablating cancerous tissue while preserving surrounding healthy tissue, focal treatment offers a promising approach to reduce metastatic spread and mortality associated with prostate cancer, Olivares begins. One of the key advantages of focal treatment is its ability to utilize various sources of energy, Olivares states. This includes thermal energy and non-thermal methods like irreversible electroporation (IRE), also known as NanoKnife, he expands. These technologies enable targeted destruction of prostate cancer cells, offering patients a less invasive treatment option with potentially fewer toxicities compared with traditional therapies such as radical prostatectomy or irradiation, Olivares explains.

However, patient selection is crucial for the success of focal treatment, Olivares continues. Candidates for this approach must have clear, visible lesions on MRI scans that correspond to biopsy-confirmed areas of cancer, he states. Patients with unilateral cancer and clear, visible lesions on MRI scans corresponding to biopsy-confirmed cancer areas are often preferred candidates for focal treatment, he details.

When understanding the consideration of focal treatment, it is essential to consider the need for more long-term follow-ups, Olivares emphasizes. Although the feasibility of focal treatment has been substantiated with 15 years of follow-up data, it's important to acknowledge that traditional treatments like radical prostatectomy or irradiation have longer-term data spanning up to 34 years, he notes. Therefore, it is important to weigh the potential benefits and risks of focal treatment against established standards of care, considering factors like treatment efficacy, adverse effects, and quality of life, Olivares concludes.