What is Focal.Therapy.UK?
Focal.Therapy.UK is the group that representatives the interests of focal therapy for the treatment of prostate cancer. We are a group of urologists or urological surgeons committees to high standards of training, conduct and delivery, and reporting of the outcomes of focal therapy in the UK.
Members of our group also collaborate with colleagues in the United States, Europ, Canada and Australia through joint consensus working, joint data collection and cross-validation of risk models and in advisory groups for regulatory entities.
Through our collaborative efforts we have shown that focal therapy is not only safe and has lower side-effects and complications compared to radical prostatectomy and radical radiotherapy or brachytherapy, but the approach of focal therapy is also effective in the majority of patients with localised prostate cancer.
Focal.Therapy.UK have set down minimal training requirements and accreditation processes which encompass device specific training programmes as well as additional requirements for urological surgeons in the UK to conduct focal therapy.
We have also set down specific criteria for those patients with prostate cancer that are eligible for focal therapy and who should be informed of this treatment as an option. Focal therapy is available in a number of NHS hospitals as well as privately through self-pay or insurance cover.
We are committed to high quality data collection and for this reason have set up NICE (UK) compliant online registries that all of our surgeons are continually submitting their data. These periodically undergo individual centre or entire UK updates for conference presentations and also for peer-reviewed journal publications.
Focal Therapy Information
What is focal therapy?
Focal therapy aims to treat areas of cancer within the prostate in order to reduce damage to surrounding tissues and lead to a lower risk of side-effects. The focal therapy procedure is a minimally invasive one with quicker recovery but requires precision delivery of the energy that destroys the cancer areas.
How do we monitor after focal therapy?
Once you have been treated, you will need to have regular PSA blood tests like all other treatments. Unlike prostatectomy or radiotherapy, following focal therapy, you will need to have MRI scans every so often. You might also need to have biopsies after treatment. You urologist will discuss the follow-up strategy we use in the UK.
Who is suitable for focal therapy?
We estimate up to 12,000 men every year are eligible for focal therapy.
Men with a PSA less than 20, confirmed prostate cancer that has not spread on a biopsy with Gleason grade 7 (3+4 or 4+3) or Gleason 6 (3+3) of a large amount.
So that we can localise the cancer areas accurately, you will also need to have a multi-parametric MRI followed by targeted and systematic biopsies (transrectal or transperineal). Most UK NHS hospitals are now doing this but sometimes these tests will need to be repeated.
If you cannot have an MRI, you will need a transperineal mapping biopsy.
What are the outcomes of focal therapy?
Prospective high quality cohort studies have shown that focal cryotherapy and focal HIFU of the prostate have been shown to be effective in controlling prostate cancer. There is also a much lower risk of side effects. Each patient's risk will vary according to what type of cancer they have and how good their function is before treatment.
Overall recurrence is 5-10% at 5-7 years versus 5-10% for radical therapy
Cancer specific survival at 5-10 years is 99%-100%
Incontinence requiring 1 or more pads 1-2% versus 5-25% for radical therapy
Impotence 5-15% vs. 50-60% for radical therapy
Rectal toxicity 0% vs. 5-10% for radiotherapy
Focal therapy energies
There are different ways to treat individual areas of the prostate that harbour the cancer. These include HIFU and cryotherapy, which are both NICE approved for clinical use through NICE IPG423 (Cryotherapy) and NICE IPG424 (HIFU). Other modalities such as irreversible electroporation are also available.
Where is focal therapy available?
Focal therapy is available in a number of NHS hospitals as well as privately and covered by almost all insurance companies.
You will need your GP or Consultant team to make a referral to your urologist and centre of choice.
Focal Therapy Surgeons
Chair of Focal Therapy UK Imperial College London & Imperial College Healthcare NHS Trust
Co-Chair, Focal Therapy UK Imperial College Healthcare NHS Trust & UCLH NHS Foundation Trust
University Hospital Southampton NHS Foundation Trust
Hampshire Hospitals NHS Foundation Trust
UCLH NHS Foundation Trust & UCL
Hampshire Hospitals NHS Foundation Trust
Oxford University Hospitals NHS Trust and Milton Keynes NHS Foundation Trust
South Tyneside and Sunderland NHS Foundation Trust & Newcastle University
UCLH NHS Foundation Trust & UCL
Royal Surrey NHS Foundation Trust & UCLH NHS Foundation Trust
UCLH NHS Foundation Trust & UCL
North Bristol NHS Trust
Betsi Cadwaladr University Health Board, Wrexham Maelor, Wales
Rivers Hospital, Essex
FOCAL THERAPY REGISTRY
HEAT for HIFU
Philip Cruz
Focal Therapy Registry
High Intensity Focused Ultrasound
The HEAT registry of HIFU cases has been collecting data on all cases and outcomes in the UK since 2004. We have regularly reported outcomes in peer reviewed conferences and journal publications. The data has also aided in device approvals internationally.
Cryotherapy
The ICE registry was formerly known as the EuCaP registry. It has been collecting outcomes on cases treated over the last 10 years throughout the UK and numerous abstracts and publications have been presented to the urology and oncology community