How Focal Therapy and High-Intensity Focused Ultrasound (HIFU) Are Used to Treat Prostate Cancer

Focal therapy for prostate cancer means treating cancer in one specific area of the prostate rather than the whole gland. Focal therapy can be performed using different techniques or energy sources. These include cryotherapy and high-intensity focused ultrasound (HIFU).^1,2

Focal therapy aims to treat prostate cancer with fewer side effects. Other prostate cancer therapies such as surgery, chemotherapy, and radiation can cause bowel, urinary, or sexual side effects such as urinary incontinence and erectile dysfunction. Focal therapy has the potential to treat prostate cancer without causing side effects. This may improve quality of life.^1,3

Who should consider focal therapy?

Focal therapy is intended for people with low- to intermediate-risk localized prostate cancer. Localized means that the cancer is contained to the prostate and has not spread to other areas beyond the prostate.^1-3

How does focal therapy work?

Focal therapy finds and treats the area within the prostate with the most aggressive cancer. This area is called the index lesion. It may be the biggest lesion or the lesion with the most abnormal cells. The index lesion is most likely to cause the cancer to spread (metastasize).¹

Your doctor will identify the index lesion through biopsy and magnetic resonance imaging (MRI). Once the index lesion has been found, there are different ways to destroy its cancer cells, including:^1-3

• Cryotherapy
• High-intensity focused ultrasound
• Laser ablation
• Photodynamic therapy

Cryotherapy

Cryotherapy is a nonsurgical technique that uses freezing cold temperatures to kill cancer cells. It is also known as cryosurgery or cryoablation. Using hollow probes, very cold gas circulates to the cells that are being targeted.¹

High-intensity focused ultrasound (HIFU)

HIFU is a minimally invasive procedure that uses ultrasound waves that are targeted at the tumor. These high-intensity sound waves cause the temperature of the targeted tissue to rise. The heat then destroys the tumor.^1,2

HIFU is commonly used in combination with MRI in order to guide the sound waves to the exact targeted area. This is known as MR-guided focused ultrasound (MRgFUS). Studies have shown that this is a safe and effective treatment option for people with prostate cancer.^2,3

HIFU does not require surgery. It is an outpatient procedure that takes about 2 hours. You are under local anesthesia during the procedure and can resume normal activities after the procedure.³

Laser ablation

Laser ablation destroys cancer cells using a focused beam of electromagnetic radiation. This burns away the tissue that is cancerous. MRI has been used together with laser ablation to produce an even more targeted treatment approach.¹

Photodynamic therapy

Photodynamic therapy uses a drug called a photosensitizer. This drug is given by mouth, spread over the skin, or injected into the bloodstream. Cancer cells then absorb the photosensitizer. When the cells are exposed to a certain wavelength of light (for example, a laser), the drug produces a form of oxygen that kills the cancer cells.^1,4

What does the research show?

A 2022 phase 2 clinical trial found that MRI-guided HIFU was successful in controlling prostate cancer in men with intermediate risk. The treatment also reduced negative side effects like urinary and sexual problems.^3,5

Experts agree that this is an incredible step forward in the treatment of prostate cancer. It means that people with low- to intermediate-risk prostate cancer may be able to avoid more radical therapies like surgery, chemotherapy, and radiation.^3,5

Talk with your doctor

In the past, focal therapy was mostly used as an alternative to active surveillance for those with very low-risk prostate cancer. But thanks to recent advances in treatment techniques, focal therapy is now expanding to intermediate-risk patients. If you have prostate cancer, talk with your doctor about whether you are a good candidate for focal therapy.^1-3