With the advent of the prostate specific antigen (PSA) test, a blood test that can indicate prostate cancer, more men are being diagnosed with prostate cancer while it is still curable. The contemporary treatment options are either radical therapies which entail surgical removal or irradiation of the prostate, or active surveillance which leaves the cancer untreated until there is clinical evidence of progression.
In some cases, radical total-gland therapy can be considered overtreatment. While this approach offers superior oncologic control, the majority of men will experience long term, lifestyle altering side effects such as incontinence or sexual dysfunction and will find the outcome bothersome. On the other end of the treatment spectrum is active surveillance which, in theory, allows the patient to defer treatment until PSA or biopsy indicates progression. In many cases however, active surveillance is poorly adhered to by patients and physicians, and many men seek radical treatment. This can be the result of feeling uncomfortable with the idea of leaving a curable cancer untreated and possibly missing the opportunity for cure.
Focal therapy (FT) can be viewed as the middle ground between radical therapy and active surveillance - cancer control without the invasiveness or side effects of surgery. Although this approach is new for prostate cancer, FT is used extensively for other diseases, for example lumpectomy for breast cancer and cryotherapy for cervical cancer. The goal of FT is to destroy only the most aggressive tumour while leaving the surrounding healthy tissue unaffected. Even if additional, smaller tumours remain within the prostate, these are unlikely to cause progression because they contain less aggressive disease.
Focal Laser Thermal Therapy (FLTT)
FLTT is a focal therapy technique that is being developed at the Princess Margaret, and is showing promising results. It is a minimally-invasive surgical procedure that uses a tiny laser fiber to target and heat the tumour within the prostate. The procedure at The Princess Margaret uses MRI for real-time monitoring of the prostate to ensure the tumour is targeted and reaches theraputic temperatures.
High Intensity Focused Ultrasound (HIFU)
HIFU is an acoustic ablation technique that uses intersecting, precision focused ultrasound waves to raise the temperature of the target tissue to more than 80 to 90 degrees Celsius in two to three seconds, destroying the targeted cancerous tissues. It is also minimally invasive and shows promising results.
High-Dose-Rate (HDR) Brachytherapy
High-Dose-Rate (HDR) brachytherapy is a type of radiation that is given internally. 1-6 plastic tubes (catheters) are inserted into the tumor through a needle under the guidance of MRI, and later connected to a brachytherapy machine to deliver your treatment using a radioactive seed. You are asleep during this procedure. When you awake, the catheters and radioactive seeds will have been already removed. The focal brachytherapy procedure lasts 4-6 hours.
HDR brachytherapy is usually performed under the guidance of ultrasound and targets the whole prostate gland. Here at Princess Margaret Hospital, we perform these procedures directly under the guidance of MRI and only target the tumor. This is possible in our state-of-the-art brachytherapy suite where the MRI can be moved on rails to help guide the procedure.
MRI-guided Radiotherapy with Integrated Focal Boost
Each day that you come for radiotherapy treatment, a boost of dose can be delivered to the tumor inside your prostate gland under the direct guidance of MRI. This technique is completely non-invasive, and can be delivered in the same time as a standard radiation treatment. This is possible in our state-of-the-art radiotherapy suite where the MRI can be moved on rails to help guide the procedure.
Focal therapy for prostate cancer is a fairly new treatment, some appraoches of which are currently in clinicl trials. Because it is a localized treatment it is mainly recommended for cases of prostate cancer that are found early and confined to the prostate. For clinical trials, only patients who fulfill very specific criteria will be able to undergo this treatment. To find out if you qualify for this treatment you should speak with your doctor.