DR CHEW-LIN YIP | UROLOGIST

Focal therapy treats the part of the prostate where clinically significant cancer has been identified, rather than treating the whole gland. The intention is to control the known cancer while limiting treatment to the remaining prostate and nearby structures. Prostate tissue outside the planned treatment area remains in place and continues to require monitoring.

Focal therapies remain emerging and experimental. Evidence about long-term cancer control, side effects and the likelihood of needing further treatment is still developing. Careful counselling and structured follow-up are therefore important, and focal treatment is generally considered within a clinical trial or prospective registry.

Focal therapy may be discussed for carefully selected men with localised prostate cancer where the clinically significant cancer appears confined to one clearly defined area. Assessment usually requires high-quality prostate MRI together with targeted and systematic or template-mapping biopsies. The cancer’s grade, size, position and extent, as well as urinary function and general health, are considered. MRI alone cannot establish suitability.

Focal brachytherapy is a form of internal radiation treatment. Permanent low-dose-rate radioactive seeds are placed into the planned part of the prostate containing the identified cancer, together with a treatment margin, rather than throughout the entire gland. Depending on the cancer’s location and extent, the treated area may be a defined focus, a sector or approximately half of the prostate (hemigland). Planning combines MRI, biopsy and ultrasound findings and involves a multidisciplinary team.

Prostate cancer is often present in more than one part of the gland, including small areas that may not be detected on current imaging or biopsy. Focal brachytherapy may therefore leave significant cancer untreated elsewhere in the prostate. Follow-up usually includes PSA tests, clinical review, repeat MRI and further biopsy; PSA alone cannot reliably show whether all significant cancer has been controlled. Cancer may persist or later be found inside or outside the treated area, and further treatment may be needed.

Focal brachytherapy can still cause urinary frequency, urgency, burning, slower flow, discomfort, bleeding, infection or urinary retention. Sexual function may change, and bowel effects are possible. The type and duration of side effects vary between patients. A detailed review of the MRI, biopsy findings, urinary function and overall health is required before focal brachytherapy can be considered. This information is general and does not replace individual medical advice.