Targeted prostate cancer treatment cuts risk of side effects, study suggests
A less invasive treatment for prostate cancer is as effective as surgery or radiotherapy but with a lower risk of side effects, a large study suggests.
In the treatment called focal therapy, high-intensity ultrasound or freezing cryotherapy is used to destroy cancerous tissue.
A 10-year NHS study led by Imperial College London followed nearly 3,500 men who received the treatment, providing long-term data that medical regulators have previously said was missing.
Researchers say the results are “excellent” and will likely increase pressure to make focal therapy more widely available.
Research ‘could change conversations’
Nearly all of the men had intermediate- or high-risk prostate cancer; but only two died of the disease 10 years after treatment.
These results are as good as surgery or radiotherapy, but the risk of side effects such as urinary incontinence or loss of sexual function is less than half.
Joint senior author Professor Hashim Ahmed, consultant urologist at Imperial College London and Imperial College Healthcare NHS Trust, said the findings showed “focal therapy provides excellent long-term cancer control in a wide range of patients”.
“It is challenging for more centers to offer this treatment,” he added.
Focus therapy was introduced more than 20 years ago, but currently only 1,000 men a year in the UK receive the treatment – although there are 15,000 who could benefit.
The therapy is not suitable for men whose cancer is in many parts of their prostate or has spread outside the prostate.
Rob Huxford had focal therapy in 2020 and had no long-term side effects [BBC]
Rob Huxford was diagnosed with prostate cancer in 2020 at the age of 44.
He says he feels “incredibly lucky” that his doctor recommended focal therapy to him.
“My results have been amazing,” he says. “I have no long-term problems and it feels quite unfair that this isn’t available to men across the country. I was offered this treatment by the fact that I live in London.”
Paul Sayer, 70, founder of charity Prost8 UK, has also benefited from focal therapy and says this new study is incredibly important.
“Our hope is that this evidence points to the point where focal therapy is routinely offered as part of treatment options to every eligible man, regardless of where he lives,” he told the BBC.
“This research shouldn’t just change clinical practice; it should change conversations in every consulting room in the UK.”
So why was it used so little?
The main reason why the therapy has not been more widely implemented to date is concerns about long-term survival and whether treating only part of the prostate will lead to higher relapses.
This study suggests these fears are largely unfounded, but health regulator NICE has not approved focal therapy as a routine treatment due to limited long-term evidence.
This means that hospitals do not have to offer this service to patients.
As a result, routine access to the NHS is limited to 10 centers in England and none elsewhere in the UK; This is something prostate cancer campaigners have decried as the “postcode lottery”.
Last month the government pledged £2.8 million to expand focal therapy provision in England and create several new centres.
There are calls for focal therapy to be made more widely available [BBC]
Preet Kaur Gill, Minister for Health Innovation and Safety, said: “Our National Cancer Plan sets out our ambition to transform cancer care and supporting innovations such as focal therapy is exactly how we are delivering on that promise.”
The charity Prostate Cancer UK said focal therapy “could help thousands of men avoid unnecessary side effects each year” and called on NICE to review the evidence.
“Side effects such as urinary incontinence or sexual problems can be devastating, and this is the first long-term study to show that many men can avoid them without increasing the risk of their cancer returning,” says the charity’s Amy Rylance.
“And it’s not just important for individual men. These serious side effects are an important reason why we don’t yet have prostate cancer screening, and reducing them makes it much more likely that we can reach a screening program for all men sooner.”
Hope for future screening program
Many high-profile celebrities have announced that they have prostate cancer; Among them is Olympic cycling legend Sir Chris Hoy, who publicly announced he has terminal prostate cancer.
Former Prime Minister Lord Cameron announced last year that he treated prostate cancer using focal therapy and said it was “not right” that many men could not access treatment.
TV presenter Jeremy Clarkson, who is currently in recovery, also underwent focal therapy.
Lord Cameron says he is being treated for prostate cancer using focal therapy [Getty Images]
All men diagnosed with prostate cancer as part of the ‘Transform’ screening study will, if eligible, be offered focal therapy to treat their disease.
The £60 million trial is looking at the best way to deliver targeted prostate cancer screening by combining fast MRI scans with less damaging treatments such as focal therapy.
This latest study, published in the European journal Urology, is another important piece of the puzzle that could help establish a national prostate cancer screening program in the coming years.
Prostate cancer is the most common cancer in men in the UK; More than 64,000 people are diagnosed and approximately 12,000 die from the disease each year.
