The largest and longest analysis of focal therapy for prostate cancer to date has been published in European Urology. Led by Alexander Light, Prof. Hashim Ahmed and Taimur Shah from Imperial College London, the study analysed 3,477 patients from the prospective UK HEAT and ICE registries, treated at 14 centres between 2004 and 2024. The result: ten years after focal HIFU or cryotherapy, cancer-specific survival stands at 99.9%.

Focal therapy targets only the tumour-bearing part of the prostate while sparing the surrounding healthy tissue. The aim is cancer control comparable to radical treatment, with considerably less impact on continence and erectile function. What had been missing so far were robust long-term data over ten years. The two nationally maintained registries HEAT (HIFU Evaluation and Assessment of Treatment) and ICE (International Cryotherapy Evaluation) now close this gap.

Patient cohor

2,897 patients were treated with focal HIFU (Sonablate HIFU system) and 580 with cryotherapy. The treatment protocol allowed up to two focal ablative sessions. The risk profile is notable: according to the EAU 2025 classification, 48% had favourable intermediate-risk, 23% unfavourable intermediate-risk and 25% high-risk disease – only 4.3% were low-risk patients. The vast majority were therefore clinically significant cancers that would otherwise have been treated with radical surgery or radiotherapy.

Key findings

• Cancer-specific mortality: 0.13% (95% CI 0.027–0.45%), corresponding to 99.9% cancer-specific survival
• Metastases: 3.3% (95% CI 2.1–4.9%)
• All-cause mortality: 12%
• Use of androgen-deprivation therapy: 14%
• Local retreatment: 33%; transition to radical treatment: 30% (intention-to-treat)
• With strict adherence to the protocol of up to two focal sessions, only around one in ten patients required radical treatment in the per-protocol analysis

Previous analyses by the same group also confirm the favourable functional profile of focal therapy: erectile dysfunction in 5–15% of patients, pad use in 1%, rectal toxicity in 0.1%.

Significance

The authors conclude that focal therapy may be considered a first-line option alongside radical treatment for well-selected patients.

In an accompanying editorial in European Urology, Armando Stabile and Francesco Montorsi (Vita-Salute San Raffaele University, Milan) describe the study as the most mature oncological data on focal therapy to date and see it as confirmation of long-term cancer control. Their conclusion: focal therapy has moved beyond proof of concept; while randomised trials remain essential, the growing body of prospective long-term evidence can no longer be dismissed as exploratory – focal therapy is contributing to a broader paradigm shift in the management of prostate cancer.

Reference: Light A, Peters M, Gopalakrishnan A, et al. Oncological Outcomes Following Focal HIFU and Cryotherapy for Treatment of Nonmetastatic Prostate Cancer in the United Kingdom: An Updated Analysis of 3477 Patients from the Prospective HEAT and ICE Registries. Eur Urol. Published online July 2026. doi:10.1016/j.eururo.2026.05.007 (Open Access, CC BY 4.0)
Editorial: Stabile A, Montorsi F. Focal Therapy for Localized Prostate Cancer: Maturing Evidence, Evolving Questions. Eur Urol. 2026. doi:10.1016/j.eururo.2026.06.015

Read more in European Urology: https://www.europeanurology.com/article/S0302-2838(26)02169-X/fulltext