What is Focal Therapy?
The use of focal or hemi therapy with HIFU while still in its infancy may offer some hope for such men. Focal therapy will allow treatment of small cancers with low side effects while not precluding later radical treatment if indicated. According to Professor Emberton professor of urology UCL and an expert in active surveillance vs focal therapy, the arguments in favor of focal therapy are
1) relief of potential psychological burden - offering these men some form of treatment is better than none
2) reduction of cancer progression rate (approximately one third of men on active surveillance require delayed intervention within 5 years).
The proponents of active surveillance argue that most men can avoid treatment and those that have delayed intervention have a period of time free of treatment-related side effects. However, the period of low side effects could be extended if focal therapy were to be carried out at diagnosis.The arguments against focal therapy for men who are suitable for active surveillance is that any treatment within this group is liable to be over-treatment and subject to some side effects. Hemi therapy with HIFU however appears to have a similar side effect profile compared to AS at least in the short term. A randomized trial comparing HIFU to radical surgery is currently underway and should answer some of the longer term follow up questions.
HIFU is further discussed in our other website www.hifuforradiationfailure.com
The survival statistics on prostate cancer continue to improve every year because of the advances in health care available in the US and developed nations. According to the American Cancer Society, and NIH the most recent data, when including all stages of prostate cancer reveal that: the 5-year relative survival rate is almost 100%; the 10-year relative survival rate is 98%;the 15-year relative survival rate is 95%.
Keep in mind that just as 5-year survival rates are based on men diagnosed and first treated more than 5 years ago, 10-year survival rates are based on men diagnosed more than 10 years ago. The 5-year survival rate is the percentage of people who live at least 5 years after being diagnosed with cancer. For example, a 5-year survival rate of 90% means that an estimated 90 out of 100 people who have that cancer are still alive 5 years after being diagnosed. Many of these people live much longer than 5 years after diagnosis.
“Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today,” - American Cancer Society.
According to the National Institutes of Health, the overall diagnosis of new cases of prostate cancer have been falling an average of 5% percent annually over the last decade, while the death rate has decreased an average of 3.6% from 2004 through 2013. In 1975, the 5-year relative survival rate was only 66%, which increased to 88.4% in 1990 and is currently at 99.9%.
Many men as well as their doctors have doubts about the efficacy of surveillance programs in a non university setting without access to the latest in technology. Men are not sure if their urologist and primary care are aware of the latest advances or if they have access to these technologies. The average urologist in private practice in the US does not have the time or clinical support to conduct an active surveillance program where monitoring can be compromised due to inadequate resources for careful follow up. Some men are seeking a compromise between no treatment versus limited treatment with low side effects. Anxiety and the uncertainty of disease progression are major reasons cited by the 30- 50% of patients who end up with treatment within 2 years despite starting on a surveillance program.