16265 Prostate Cancer Focal Therapy

Overview

Focal therapy is a treatment for prostate cancer that aims to destroy only the cancer inside the prostate while leaving as much healthy prostate tissue as possible. It is sometimes called focal ablation, which means destroying tissue in a small, targeted area. Doctors use energy such as heat, cold, laser, or electrical pulses to kill cancer cells in the chosen area. It is not a treatment for cancer that has spread outside the prostate, and it is not suitable for everyone.

Prostate cancer is common. Focal therapy is a specialised option and is not suitable for everyone.

It mainly affects men over 50. Risk is higher in Black men and in men with a family history. Anyone with a prostate can get prostate cancer, but it is very rare under 40 and does not occur in children.

Symptoms

Common symptoms

• Early prostate cancer often causes no symptoms at all.
• Needing to pass urine more often, especially at night.
• A weak or interrupted urine stream.
• Trouble starting to pass urine or feeling that the bladder is not empty.
• Blood in urine or semen.
• Pain when passing urine or when ejaculating.
• Pain in the back, hips, or pelvis.
• Unexplained weight loss and tiredness, especially if the cancer has spread.

Symptoms in children

• Prostate cancer does not occur in children. Children with urinary symptoms need a doctor to check for other causes, such as infection.

Symptoms in older adults

• Older adults are more likely to get prostate cancer, and urinary symptoms are often caused by a non-cancerous enlarged prostate. New or worsening urinary symptoms should still be checked.

Causes

Main causes

• Prostate cancer starts when cells in the prostate gland develop changes in their DNA and grow out of control.
• The exact trigger for these changes is not known. Focal therapy is a treatment, not a cause.

Risk factors

• Being over 50; risk rises with age.
• Being a Black man, which is linked to a higher risk.
• Having a father or brother with prostate cancer.
• Inherited gene changes, such as changes in BRCA1 or BRCA2.
• Obesity and a less healthy lifestyle may raise risk, but the evidence is not clear for every factor.

When to see a doctor

See a doctor urgently if:

• You cannot pass urine and are in severe pain or have a swollen abdomen.
• You have heavy blood in your urine with clots or feel faint.
• You have sudden severe back pain with numbness, leg weakness, or loss of bladder or bowel control.
• You have a high fever with confusion or shaking chills, especially with urinary symptoms.

Book a routine appointment if:

• You have urinary changes that last more than a few days.
• You want to discuss your prostate cancer risk or PSA testing.
• You have a family history of prostate cancer.
• You are due for follow-up after prostate cancer treatment.

Diagnosis

Doctors look at PSA blood test results, examine the prostate, review MRI scans, and confirm cancer with a biopsy. For focal therapy, the team also needs a detailed map of where the cancer is and whether it is in one area or several.

Tests that may be done

• PSA blood test, which measures a protein made by the prostate.
• Digital rectal examination, where a doctor feels the prostate through the back passage.
• Multiparametric MRI scan, which gives detailed pictures of the prostate.
• Targeted biopsy, where small samples are taken from suspicious areas.
• Template biopsy, which takes samples from many parts of the prostate when needed.
• Genomic tests on biopsy tissue, which can give more information about how aggressive the cancer may be.

What to expect at your appointment

You may have several appointments with a urologist and a specialist team. Results can take a week or more. Bring questions and ask about the benefits, risks, and follow-up plan. A second opinion is reasonable if you want one.

Treatment

Treatment for prostate cancer depends on the grade, size, location, and spread of the cancer, plus your age, general health, and preferences. Focal therapy is one option for some men with cancer confined to the prostate. Other options include active surveillance, surgery, and radiotherapy. Your team should explain all suitable choices.

Self-care at home

• Ask your treatment team about pelvic floor exercises before and after treatment.
• Stop smoking if you smoke, and ask for help to quit.
• Keep active and eat a balanced diet.
• Write down your questions and bring someone to appointments if you can.
• Ask about fertility and sperm banking before treatment if this matters to you.

Medical treatments

Doctors may use active surveillance, which means regular checks without immediate treatment; focal therapy, which targets the cancer area; radiotherapy; surgery; hormone therapy; or chemotherapy for advanced cancer. Each approach has different benefits, risks, and side effects. The best choice is personal and should be discussed with your specialist team.

When is surgery considered?

Surgery to remove the prostate may be recommended if the cancer is higher risk, is in more than one area, is too large for focal therapy, or if you prefer surgery. It may also be used when focal therapy is not likely to control the cancer. Your team will explain the risks and side effects.

Living with this condition

After focal therapy, you will usually have a temporary catheter and follow-up visits. You will need regular PSA tests, MRI scans, and sometimes biopsies to check the cancer has not returned. Urinary and sexual side effects often improve over weeks to months, but some can last. Ask your team what to expect and when to call.

Lifestyle tips

• Stay physically active within your comfort and advice from your team.
• Eat a balanced diet rich in vegetables, fruit, whole grains, and healthy proteins.
• Limit alcohol and avoid smoking.
• Keep a healthy weight.
• Do pelvic floor exercises if advised.
• Get enough sleep and manage stress.

Diet and exercise

A heart-healthy diet and regular activity support recovery and overall health. Aim for moderate exercise most days if your team says it is safe. A dietitian or physiotherapist can help if you need personalised advice.

Mental health and emotional wellbeing

It is normal to feel anxious, low, or worried about cancer, treatment, sexual function, or follow-up. These feelings can affect relationships and sleep. Tell your GP or specialist team if they are weighing on you; talking therapy and support groups can help. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support service right away.

Prevention

There is no sure way to prevent prostate cancer. A healthy lifestyle may support overall health and may lower risk, but it cannot guarantee protection. Talk with your doctor about your personal risk.

Vaccines

There is no vaccine to prevent prostate cancer.

Screening programmes

In the UK, there is no national prostate cancer screening programme. Men can ask their GP about a PSA blood test after discussing the benefits and harms. Screening decisions should be personal and based on your risk and preferences.

Complications

If left untreated

• The cancer may grow inside the prostate and cause urinary problems or pain.
• It may spread to lymph nodes or bones, which can cause bone pain, fractures, or other symptoms.
• Advanced cancer can be life-limiting.
• Some prostate cancers are slow-growing and may not cause problems for many years.

Long-term outlook

The outlook for prostate cancer is often good, especially when it is found early. Focal therapy aims to control cancer while reducing side effects, but it is newer than surgery or radiotherapy and long-term evidence is still growing. Regular follow-up is important so any return can be found and treated.

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