From Entire Prostate Removal to Focal Therapy: What to Know and How to Choose the Right Treatment for Prostate Cancer

Historically, trying to treat only part of the prostate, or subtotal treatment, had not been possible due to the deep anatomical location of the organ. Therefore, total destruction or removal of the prostate has been the “medical law of the land” for many years. 

However, with the advent of active surveillance and the realization that if technology made it possible we would treat only the diseased portion of the prostate.  Therefore, subtotal treatment became worthy of consideration.  At first, this concept was not looked upon favorably, but is now embraced by a substantial portion of the urologic community. 

One of the leading technologies for subtotal treatment is high intensity focused ultrasonography (HIFU).  HIFU, which ablates the prostate by heating and destroying the diseased tissue, was approved by the US Food and Drug Administration for prostate tissue ablation in 2015. HIFU was initially used for whole gland ablation, and has been proven effective for over two decades in Europe, and other regions around the world.

Today, with subtotal treatment of the prostate, the urologist can use HIFU to perform a hemi-ablation (treating half the prostate), or focal therapy (treating focal areas of disease), especially those identified by MRI with no other areas of disease, or multiple focal areas identified by MRI that can also be treated focally.  The newest generation of HIFU, Focal One, makes possible for individualized and flexible treatment planning to avoid ablating the entire prostate.  

Hemi-ablation or focal therapy offer a chance to avoid the possibility of injuring both sets of neurovascular bundles that assist in male sexual function. If we only treat one side of the prostate, the other side not being treated clearly protects the nerves on that side.  So the risks of erectile dysfunction and leakage of urine goes down significantly with less than total gland ablation. 

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