“I would like focal therapy to work for local prostate cancer because it would help us do a few things. We could spare nerves for sexual function and treat just one side of the prostate with cryo or HIFU or laser interstitial therapy.
But the natural history of the tumor biology isn’t well known because prostate cancer is multifocal. If we knew how to identify the part of the prostate that had the tumor and whether it would be lethal, then I would say let’s do focal cryotherapy.
In terms of HIFU and interstitial laser therapy, I don’t know if the data exists yet on whether they can treat tumors effectively. I know cryosurgery can. But focal treatment is going to be an academic question. Private practitioners won’t answer that. It will be done in an academic center where a doctor does prostate MRI imaging, identifies various lesions, then takes samples of each lesion and does focal therapy—probably cryo—and then we look at outcomes. It’s got to be studied at an academic center.
I do know there’s a higher chance you’ll be able to continue to be active sexually if focal cryotherapy is done versus whole-gland cryotherapy. That’s a big deal for men who are interested in sexual intercourse. Obviously, cryo will not affect continence, as surgery might. If they were able to prove that, I would offer it to my patients. But I don’t see that happening until studies are done. It would be better if patients didn’t risk incontinence from surgery, or erectile dysfunction from either surgery or radiation.”
Kurt Strom, MD