Targeted prostate cancer treatment cuts risk of side effects, study suggests

A landmark 10-year study has revealed that focal therapy, a minimally invasive treatment for prostate cancer, is as effective at controlling the disease as major surgery and radiotherapy while cutting the risk of life-changing side effects by more than half. The National Health Service research, led by Imperial College London and published in the journal European Urology, tracked nearly 3,500 men. Despite almost all participants having intermediate or high-risk cancer, only two patients died from the disease over the decade.

Supported by the National Institute for Health and Care Research, these findings could prompt health regulator NICE to review its guidelines and approve focal therapy for routine NHS use, potentially ending stark regional disparities in care. Lowering the risk of treatment-related harm also removes a major obstacle toward establishing a national prostate cancer screening programme. Currently, a 60 million pound trial named Transform is evaluating targeted screening that combines rapid MRI scans with lower-harm treatment options like focal therapy.

Prostate cancer is the most common cancer among UK men, accounting for more than 64,000 annual diagnoses and approximately 12,000 deaths. First introduced into clinical settings more than 20 years ago, focal therapy uses high-intensity ultrasound or freezing cryotherapy to target and destroy localized cancer cells. However, it is not suitable for men whose cancer has spread beyond the prostate gland or affects multiple areas of it.

Because the National Institute for Health and Care Excellence, known as NICE, previously lacked long-term data, it has not approved focal therapy for routine NHS use, leaving hospitals under no obligation to offer it. Consequently, access is restricted to just 10 centres in England and none in Scotland, Wales, or Northern Ireland, creating a geographic postcode lottery. Only about 1,000 UK men receive focal therapy annually, despite up to 15,000 who could potentially benefit.

The new study demonstrates that focal therapy matches the cancer control rates of traditional radical treatments, such as complete surgical removal of the prostate or radiotherapy. Crucially, it presents less than half the risk of common, debilitating side effects, such as urine leakage or loss of sexual function. Professor Hashim Ahmed, joint senior author of the study and Consultant Urologist at Imperial College London and Imperial College Healthcare NHS Trust, helped lead the research establishing these clinical outcomes.

Addressing the gap in access, the UK government pledged up to 2.8 million pounds last month to expand focal therapy provision and establish new specialized treatment centres across England, an initiative overseen by UK Health Innovation and Safety Minister Preet Kaur Gill.

Public awareness of the treatment has also grown as high-profile figures have shared their experiences. Former Prime Minister Lord Cameron disclosed last year that he received focal therapy, and television presenter Jeremy Clarkson has also undergone the procedure. Meanwhile, Olympic cyclist Sir Chris Hoy was noted as having terminal prostate cancer, further highlighting the severe burden of the disease.

For individual patients, the treatment offers significant quality-of-life benefits. Rob Huxford was diagnosed with prostate cancer at age 44 in 2020 and underwent successful focal therapy, reporting no long-term side effects. Patient advocates, including Paul Sayer, a 70-year-old focal therapy recipient and founder of the charity Prost8 UK, alongside Amy Rylance from Prostate Cancer UK, have strongly supported expanding access to the treatment.

Despite the positive findings, some medical experts advise caution. Dr Alastair Lamb, Clinical Reader at Barts Cancer Institute at St Bartholomew's Hospital, emphasized the importance of awaiting results from an ongoing randomised controlled trial, known as the PART Trial, to fully confirm these comparative benefits.

Ultimately, integrating focal therapy into routine care could transform the landscape of prostate cancer treatment. By providing an effective option that preserves quality of life, healthcare systems may soon be better positioned to implement widespread screening programmes that save lives.