It’s frustrating when I hear focal therapy described as experimental. There are still many naysayers among urologists and oncologists who insist that focal therapy has not yet demonstrated its merits. To address their skepticism, I turn to international expert Professor Mark Emberton of University College London. Mr. Emberton (see explanation below for why British surgeons are addressed as Mister instead of Doctor*) is one of the smartest doctors I ever met. He and his department are renowned leaders in prostate cancer interventions.
Mark Emberton on focal therapy
Emberton presented an 11-episode review on the background of focal therapy, and its impact on prostate cancer (PCa) management, and its future. (If you like listening to a posh British accent, you may want to watch Mr. Emberton’s Episode 6 on the safety and efficacy of this approach.) I want to share some of his key points based on his 10+ years of experience.
- His institution has been offering focal therapy and publishing their data for 10+ years. Although their statistics are based on focal HIFU, when his principles for patient selection and application of focal energy are adhered to, at our Sperling Prostate Center we see comparable results with Focal Laser Ablation, Exablate MRI-guided Focused Ultrasound, and TULSA-PRO.
- Focal therapy “is not a pill” so experience physician matters. No matter which modality is used, we support the advice that national PCa patient programs offer: choose the most experienced practitioner.
- Accurately qualifying patients makes a difference in terms of durable cancer control and side effect outcomes. Here again, experience makes a difference. High resolution multiparametric MRI done on a powerful magnet is great technology, but studies have shown that reader interpretations vary according to how long radiologist has been in practice with it. Knowing the size and location of the tumor to be targeted, and the individual patient’s anatomy, are essential for planning and carrying out a thorough ablation that does not inadvertently damage sexual or urinary function.
- The more thoroughly a patient’s PCa is staged, the less the chances of treatment failure. For example, a Gleason 4+3 may require more aggressive treatment than 3+4.
- The amount of ablation energy applied to the target determines the degree of recurrence risk. The target, plus an addition pre-emptive margin, must be encompassed with lethal force so no living cancer cells are left.
- Follow-up monitoring is important. It’s possible that the target lesion was destroyed, but a new cancer appears somewhere else in the gland. Emberton points out that focal treatment may be reapplied to a tumor in another location, a feature that patients appreciate.
In short, there is nothing “experimental” about focal therapy. There have been international consensus panels that have developed guidelines for patient selection, aggressiveness of treatment, methods of follow-up, and designs for apples-to-apples studies. As with all clinical innovations, there is need for ongoing, high-level research. Not only will longer term data begin to satisfy the doubters, it’s in the best interest of patients to assemble the ever-improving effectiveness, safety and side effect profile. In the meantime, leaders in focal treatment like Mr. Emberton and Dr. Sperling will be defined by excellence and proficiency.
*Trivia question: Why are British surgeons called Mister instead of Doctor?
Answer: According to the Royal College of Surgeons in England (RCSE), physicians earned a degree that entitled them to be called Doctor. However, the training of surgeons until the mid-19th century was different. They did not have to go to university to gain a degree; instead they usually served as an apprentice to a surgeon. Afterwards they took an examination. In London, after 1745, this was conducted by the Surgeons’ Company and after 1800 by The Royal College of Surgeons. If successful they were awarded a diploma, not a degree, therefore they were unable to call themselves ‘Doctor’, and stayed instead with the title ‘Mr’.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.