Multimodality focal therapy: Promising for localized prostate cancer

Multimodality focal therapy shortens operation time and hospitalization, and reduces complications in patients with localized prostate cancer, according to researchers from the Chinese University of Hong Kong (CUHK).

“Since 2019, focal therapy for prostate cancer has been introduced at Prince of Wales Hospital [PWH], first with focal high-intensity focused ultrasound [HIFU], followed by focal cryotherapy, and most recently, targeted microwave ablation [TMA],” shared Professor Anthony Chi-Fai Ng, Tzu Leung Ho Professor of Urology and Head of the Division of Urology, Department of Surgery, CUHK.

In the 5-year period from 2019 to 2024, 102 patients with localized prostate cancer (median age, 70.5 years) received focal therapy (HIFU, 43.1 percent; focal cryotherapy, 17.6 percent; TMA, 39.2 percent) at PWH. By D'Amico classification, 30.4 percent of patients were of low-risk, 64.7 percent were of intermediate-risk, and 4.9 percent were of high-risk. “For posterior tumours, which are in proximity to the rectum and nerves, focal HIFU appears to be more advantageous. Focal cryotherapy or TMA would be reserved for anterior tumours,” explained the researchers. [Prostate Int 2025;13:87-93]

Shorter operation time and hospitalization

“Focal therapy can be completed in 1–2 hours,” noted Dr Samuel Chi-Hang Yee of the Division of Urology, Department of Surgery, CUHK. Compared with conventional radical surgery (3–4 hours), operative time was reduced by 40 percent with focal HIFU (119 minutes), 60 percent with TMA (70 minutes), and 33 percent with cryotherapy (120.5 minutes).

“Over 60 percent of patients treated with focal therapy were discharged on the same day, while 85.3 percent were discharged within 24 hours postoperatively. With conventional radical surgery, 3–5 days of hospital stay were required,” reported Yee.

Recurrence rate was approximately 20 percent at 6–12 months after focal therapy. Most recurrences were low-risk (ISUP Grade Group 1) and required only routine monitoring.

Reduced complications and trauma

Urinary incontinence and erectile dysfunction are common surgical complications after radical prostatectomy. [Urol Oncol 2020;38:735.e17-735.e25] In contrast, focal therapy is a targeted approach that minimizes damage to surrounding healthy tissue. [BJUI Compass 2025;6:e70000]

Urinary function did not change at 12 months after focal HIFU (p=0.722), and improved at 12 months after focal cryotherapy (p=0.016) or TMA (p=0.006) vs baseline. No significant change in erectile function was observed after focal therapy across the three modalities, indicating reduced complications and trauma. [Prostate Int 2025;13:87-93]

“Focal therapy significantly reduces surgical trauma and psychological burden, offering a safe and effective option for low- to intermediate-risk patients who are suitable for such treatment,” commented Yee.

Personalized treatment

“Prostate cancer affects each patient differently. Treatment should therefore be personalized. About one in seven patients with localized prostate cancer is suitable for focal therapy, meaning whole-gland treatment is not always necessary,” highlighted Dr Peter Ka-Fung Chiu of the Division of Urology, Department of Surgery, CUHK. “In cases of recurrence, patients have the flexibility to repeat focal therapy or seek alternatives.”

The Hospital Authority has enlisted focal HIFU therapy as a standard treatment for localized prostate cancer. To expand treatment options, the researchers will further explore and consolidate potential applications of other focal therapies in patients with higher-risk prostate cancer.