March 2025

Prostate cancer remains a major health concern in the UK, prompting the advancement of novel treatment approaches. Among these, focal therapy has gained prominence as a precision-based method aimed at treating localized prostate cancer while preserving surrounding healthy tissue and minimizing side effects. This evolving field reflects a growing understanding of disease progression and how best to utilize targeted ablative techniques.

In a recent narrative review, Nadia Rokan and Deepika Reddy evaluated the historical development, current practices, clinical outcome reported in UK-based studies, and future directions of focal therapy for prostate cancer, highlighting its evolution as a viable treatment option.

High-Intensity Focused Ultrasound (HIFU)  as well as Cryotherapy have been available as a treatment for patients with intermediate-risk localised prostate cancer in the United Kingdom since 2005 with NICE approval within trials or prospective registries granted in 2012 confirmed in 2023, with the caveats of recording all data and publishing results. Irreversible electroporation (IRE) for treatment of prostate cancer is the most recent option to have gained NICE approval in 2016, most recently being upgraded from ‘research only’ guidance to ‘special arrangements’ of informed consent, data collection and follow-up, in 2023. 

Looking ahead, the field is set to benefit from continued innovation. Advances in imaging—particularly the application of artificial intelligence to multiparametric MRI— having the potential to improve tumour characterisation and treatment planning. Additionally, the development of new energy delivery systems may enhance the precision and efficacy of existing therapies. 

Combination therapies that integrate focal therapy with systemic treatments are being explored, which may enhance overall outcomes for patients with more aggressive disease. Research into synergistic effects between focal therapies and hormonal therapies is ongoing.

Understanding the role of focal therapy in high-risk patients will be essential for its continued development, and future studies will likely focus on growing patient selection criteria to include those with more advanced disease.

Conclusion

Focal therapy represents a significant advancement in the management of prostate cancer in the United Kingdom. With its ability to provide effective treatments while minimising side effects, it has become a valuable option for selected patients. The ongoing research, technological innovations and regulatory support will be critical in solidifying its role in routine clinical practice. As the understanding of prostate cancer evolves, so too will the strategies to combat it, with focal therapy likely to play a central role in future management paradigms.

Read more in BJUI:
https://doi.org/10.1002/bco2.70000