What is most important to prostate cancer patients?

It’s never easy to tell a patient, “You have prostate cancer.” However, if he’s found to have low-risk disease still localized (contained), the blow is softened. At that stage, treatment success rates are very high. I’m able to reassure the patient that he has every reason to believe he will live to a ripe old age.

This news is comforting because the most important thing to a prostate cancer (PCa) patient is life itself. Every PCa patient—indeed, any cancer patient—hopes to outlive their cancer. In part, this explains why many patients with localized PCa choose to have a radical prostatectomy (RP) even if their PCa is low risk. Removing the entire gland logically implies that all the PCa contained in it is gone, too. If it’s gone, the patient believes his cancer is controlled. He will keep his life, and die from some other cause.

Does prostatectomy guarantee cancer control?

Cancer control means all PCa has been removed or destroyed. Unfortunately, in today’s world no PCa treatment comes with a 100% guarantee of cancer control. That includes RP for localized PCa. According to a 2023 analysis of Veterans Administration data on 21,992 RP patients, the authors calculated 10-year incidence of biochemical recurrence (rising PSA) at 28%, and of metastasis (cancer spread) at 20%. These numbers are fairly consistent with an abundance of statistics from other studies.

Even with those numbers, PCa-specific survival at 10 years was 94%. In other words, 10 years out from their surgery, 94% of patients had not died from their cancer—the most important thing for PCa patients. While RP does not guarantee that all the PCa is gone, it offers high probability of long life.

On the other hand, focal therapy not only offers high probability of a long life by successfully controlling PCa, it also preserves a man’s quality of life. It does so by minimizing the urinary and sexual side effect risks that accompany RP.

How does focal therapy compare with prostatectomy in terms of cancer control?

Many of my patients over the years have asked me how focal therapy compares with RP in terms of oncological outcomes (cancer control). These men are drawn to focal therapy because it selectively destroys the index lesion (primary tumor) while sparing urinary and sexual function. Yet, they wonder if it’s safe to leave untreated prostate tissue behind. Here are three journal articles on how focal therapy cancer control stacks up against that of RP.

1. A 2017 study involved 55 pairs of patients (matched in age and PCa factors) in which one patient had RP while the other had HIFU hemiablation (ablate the half of the gland that had PCa but spare the other half). “HIFU hemiablation was comparable to RALP in controlling localized unilateral PCa,” with no significant difference in biochemical recurrence, but fewer side effects for HIFU patients.^[i]
2. A 2021 study matched 246 pairs in which one patient had RP while the other had focal HIFU or focal cryo. At 8 years out from treatment, average failure-free survival rates were 79% for RP vs. 83% for focal therapy. “In patients with non-metastatic low- intermediate prostate cancer, oncological outcomes over 8 years were similar between focal therapy and radical prostatectomy.”^[ii]
3. A 2025 paper reviewed 14 published studies comparing HIFU vs. RP. Though not all of the HIFU papers were focal, the authors wrote that biochemical recurrence and metastasis-free survival were similar between the treatments. They note, “Particularly as focal therapy, it shows the potential to achieve oncological outcomes comparable to [RP] while enhancing erectile function preservation, urinary continence, and reducing major complications.”^[iii]

Are there any other advantages to focal therapy?

The secret to focal treatment cancer control lies in accurate diagnosis and careful patient selection. Thanks to our own Sperling Prostate Center’s powerful 3T multiparametric MRI and our real-time MRI-guided targeted biopsy, we are able to confidently qualify patients for focal treatment. We match patients with the method that best fits the unique situation of each, whether it’s Focal Laser Ablation or focal TULSA. Patients who adhere to our follow-up protocol have peace of mind because we can detect even the earliest signs of possible PCa activity.

And, speaking of possible PCa activity after treatment, unlike RP focal therapy has an incomparable advantage. If PCa recurs after surgery and it’s still localized in the prostate bed, the only localized salvage option is radiation. However, if PCa recurs locally after focal therapy, all options remain available (surgery, radiation, another focal treatment) depending on the clinical situation and patient preference.

To sum up, for properly qualified patients, focal therapy not only has cancer control on a par with RP, it has significantly less risk of urinary and sexual side effects, it can be monitored after treatment by PSA tests and multiparametric MRI, and it does not close the door on a range of future treatment options should PCa recur. If you or a loved one is at risk for PCa, or has been newly diagnosed, contact our Center for information on how we can be of service.

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.

References

[i] Albisinni S, Aoun F, Bellucci S, Biaou I et al. Comparing High-Intensity Focal Ultrasound Hemiablation to Robotic Radical Prostatectomy in the Management of Unilateral Prostate Cancer: A Matched-Pair Analysis. J Endourol. 2017 Jan;31(1):14-19.
[ii] Shah TT, Reddy D, Peters M, Ball D et al. Focal therapy compared to radical prostatectomy for non-metastatic prostate cancer: a propensity score-matched study. Prostate Cancer Prostatic Dis. 2021 Jun;24(2):567-574.
[iii] Lepine HL, Vicentini FC, Filho CM, Cavalcante G et al. Evaluating less-invasive strategies for localized prostate cancer: a comparative meta-analysis on high-intensity focused ultrasound versus radical prostatectomy. Int Urol Nephrol. 2025 Jul 31.