Focal Therapy
Urologic oncologist Dr. Jim Hu provides an overview of focal therapy for prostate cancer — who it may be right for, and what patients should know before pursuing it. Highlights of this video include:
- Focal therapy is considered investigational: there is not yet enough long-term data and studies comparing it to established treatments (surgery, radiation therapy)
- Patients who may be good candidates are generally those with a single area of lower-grade (Grade Group 2) cancer that shows up clearly on MRI
- Four out of 10 men who have focal therapy are found to have cancer elsewhere in the prostate within two years
- A patient’s personal priorities — such as protecting sexual function — play an important role in this decision
Speakers:
Jim C. Hu, MD, MPH, Professor of Urology, Weill Cornell Medicine
Phillip Koo, MD, Chief Medical Officer, Prostate Cancer Foundation
Phillip Koo, MD [00:00:00] What’s the latest on focal therapy? Which patients should get focal therapy or should they? But just real quickly, I know that would probably be a topic in and of itself.
Jim Hu, MD, MPH [00:00:09] Absolutely. So, as I, just to dovetail on to what I said earlier, low-risk prostate cancer grade group one, we think that should be watched. Only get focal therapy for low-risk disease if you have anxiety, although there’s a randomized trial that shows that there’s less low-risk, prostate cancer, if you do subsequent biopsies on active surveillance. So, the sweet spot right now. And again, I’ll go back to what I said early about professional guidelines. That’s the expert’s opinions based on evidence. But right now, focal therapy is labeled as investigational because there isn’t a lot of long-term data. There’s not a lot of comparative data. And so, the sweet spot I see for focal therapy right now is, again, grade group two prostate cancer, low percent pattern four. So really, you’re a candidate that can do active surveillance, but they have an MRI-visible lesion, meaning a targeted biopsy with MRI guidance only found cancer in that MRI- visible area. But now, the caveat is, even when that’s been well-studied, you have to do repeat biopsies in contrast to just getting PSAs after surgery or radiation to monitor the cancer status. And so, the caveat there is on biopsies up to two years after the focal therapy, 40% of men are found to have significant cancer that is grade group two or higher as somewhere else within the prostate. And so just understand that you may be kicking the can down the road 40 years and we’re one of the few centers that have compared surgery to focal therapy outcomes. You know, when you look five years out, the failure rate of focal therapy is almost seven times higher than surgery and also 3% of men went on to get metastatic disease who got focal therapy, maybe thinking that they were cured or that issue was taken care of. So really, I think it’s an issue of buyer beware until there’s more evidence out there. Although I’d go back to say, patient preferences drive it, right? You’re valuing preservation of really erectile function in most cases, as much as cure of cancer to consider focal therapy.
Phillip Koo, MD [00:02:09] Great, thank you. So, for those considering focal therapy, I guess today it is investigation. Just ask the right questions and just be aware before going down that path.