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Focal Therapy Treatment for Prostate Cancer

When faced with a prostate cancer diagnosis, understanding your treatment options becomes crucial for making informed decisions about your health. Focal therapy treats cancer that is localised within a small portion of the prostate by using different energy forms (for example heat or freezing energy) to destroy cancer cells. Focal therapy is currently still considered to be under research study, but may in the near future provide an alternative to traditional surgery or radiation for suitable patients. At our clinic, our MOH-accredited urologist has undergone training in focal therapy to help patients manage their prostate cancer effectively.

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Dr Tan Teck Wei

MBBS|DFD (CAW)|MRCS|MMed (Surgery)|FAMS (Urology)

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What is Focal Therapy?

Focal therapy for prostate cancer is a minimally invasive procedure that uses controlled energy to destroy cancerous tissue within the prostate gland. Two of the commonest forms of energy sources used include High-Intensity Focused Ultrasound (HIFU) and cryotherapy.

In HIFU, heat is generated by an ultrasound probe that is inserted into the rectum and directed towards the region with prostate cancer, resulting in death of the cancer cells. For cryotherapy, thin needles (cryoprobes) are inserted through the perineum (the area between the scrotum and rectum) directly into the prostate under ultrasound guidance. These probes deliver argon gas to create ice balls that freeze and destroy targeted cancer cells. The body naturally absorbs the dead tissue over time.

Who is a Suitable Candidate?

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Ideal Candidates

  • Men with localised prostate cancer confined to the prostate gland
  • Patients with low to intermediate-risk prostate cancer, based on PSA levels, Gleason score, and clinical staging
  • Individuals seeking alternatives to surgery or radiation therapy
  • Men with recurrent cancer after radiation therapy
  • Patients with comorbidities that increase surgical risk
  • Slowed or delayed start of the urinary stream
  • Those preferring a minimally invasive treatment with shorter recovery time
  • Men concerned about preserving urinary and sexual function when clinically appropriate
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Contraindications

  • Advanced prostate cancer with spread beyond the prostate gland
  • High-grade prostate cancer
  • Inability to tolerate general or spinal anaesthesia
  • Active urinary tract infection
  • Uncontrolled bleeding disorders or use of anticoagulants that cannot be safely paused

The determination of suitability for focal therapy requires comprehensive evaluation by an experienced urologist. Factors including prostate size, tumour location, and individual health status all influence whether =focal therapy represents an appropriate treatment choice. A thorough assessment including imaging studies and biopsy results helps guide this decision.

The Focal Therapy Treatment Process

  • Pre-Treatment Preparation

    Before focal therapy, patients undergo comprehensive evaluation including updated PSA testing, imaging studies, and possibly repeat biopsies to confirm cancer location. Patients must stop blood-thinning medications according to their urologist’s instructions. Antibiotics are typically started to prevent infection. Pre-operative assessment ensures fitness for anaesthesia, and patients arrange transport home after the procedure.

  • During the Procedure

    The focal therapy procedure begins with the patient under general or spinal anaesthesia. Using transrectal ultrasound guidance, the urologist utilises the chosen energy source to direct the treatment towards the region of the prostate with cancer. The entire procedure typically takes 1 to 2 hours.

  • Immediate Post-Treatment

    Following focal therapy, patients recover in the post-anaesthesia unit for monitoring. A urinary catheter remains in place for about a week to allow the prostate to heal and prevent urinary retention from swelling. Most patients experience minimal pain, manageable with oral medications. Hospital discharge usually occurs the same day or after an overnight stay. Patients receive detailed instructions for catheter care, activity restrictions, and warning signs requiring immediate medical attention.

Recovery & Aftercare

  • Long-term Recovery

    Complete healing takes several weeks to months. PSA levels are monitored starting at three months post-treatment to assess effectiveness. Regular follow-up includes PSA testing every few months and MRI prostate scan about 6 to 12 months after the procedure. Most patients will require a repeat prostate biopsy within a year of treatment to ensure there is no residual or new cancer. Most men experience gradual improvement in urinary symptoms over 3-6 months. Sexual function recovery varies but may take up to one to two years for maximum improvement.

  • First 24-48 Hours

    The initial recovery period focuses on rest and allowing anaesthesia effects to resolve. Mild perineal or rectal discomfort and bruising are normal, controlled with prescribed pain medication. Patients should drink plenty of fluids to flush the urinary system and prevent infection. Light activities like walking are encouraged, but lifting and strenuous exercise must be avoided. Some blood in the urine is normal. The catheter requires careful maintenance to prevent blockage or infection.

  • First Week

    Commonly used for infants and young children, this method involves placing a plastic ring between the foreskin and glans. The foreskin is tied over the ring, cutting off its blood supply. The foreskin and ring typically fall off naturally within 7-10 days.

Risks & Potential Complications

Common Side Effects

Temporary urinary symptoms affect most patients, including increased frequency, urgency, and weak stream lasting several weeks to months. Mild perineal or rectal swelling and bruising resolve within days. Blood in the urine appears initially but clears with hydration. Temporary erectile dysfunction occurs in many patients, with recovery potential depending on treatment extent and baseline function. These effects are typically managed with medications and resolve with time.

Rare Complications

Serious complications remain uncommon with experienced surgeons using modern equipment. Urethral sloughing (tissue shedding) may require temporary catheterisation. Rectourethral fistula (abnormal connection between rectum and urethra) occurs in less than 1% of cases with current techniques. Urinary incontinence risk is low. Chronic pain or numbness in the treatment area affects a small number of patients.

Benefits of Focal Therapy Treatment

Focal therapy is still not considered standard treatment for prostate cancer at this point in time as there is no longer term data supporting its effectiveness compared to surgery or radiation therapy. Most of the studies also report that 20-30% of prostate cancer can persist or recur after focal therapy.
Focal therapy offers several advantages for suitable prostate cancer patients. The minimally invasive nature means no surgical incisions, reducing infection risk and recovery time compared to radical prostatectomy. Most patients return home the same day with minimal discomfort.
In addition, focal therapy allows preservation of surrounding structures around the prostate. By targeting only the cancerous areas, focal therapy has a significantly higher likelihood of preservation of urinary continence and sexual function than whole-gland treatments such as surgery and radiation therapy. The procedure is repeatable if necessary, unlike radiation therapy.
Recovery typically occurs faster than with surgery, with most men resuming normal activities within two weeks. It is an option for suitable patients who strongly wish to preserve urinary continence and sexual function, or who cannot undergo surgery due to medical conditions, or those seeking to avoid radiation exposure.

Focal Therapy Cost Considerations in Singapore

Focal therapy treatment costs vary based on several factors including the extent of treatment, hospital facility fees, anaesthesia requirements, and post-procedure care needs. The comprehensive fee typically covers the surgical procedure, operating room use, specialised equipment, and immediate recovery care.

Additional considerations include pre-treatment evaluations such as imaging studies and biopsies, which may incur separate charges. Post-treatment monitoring with regular PSA tests and MRI scans, and follow-up consultations represents ongoing expenses. Some patients require medications for temporary side effects.

While specific pricing requires individual consultation, investing in quality care with experienced urologists using established equipment often proves valuable for long-term outcomes. Our clinic provides detailed cost breakdowns during consultation, helping patients understand all associated expenses and plan accordingly.

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Dr Tan Teck Wei

MBBS (S’pore)

DFD (CAW)

MRCS (Edin)

MMed (Surgery)

FAMS (Urology)

A Senior Consultant Urologist in Singapore, Dr Tan Teck Wei specialises in the management of complex urological cancers involving the kidneys, prostate, and bladder.

He is fellowship-trained in open, laparoscopic and robotic surgery. He also specialises in the management of other urological conditions including:

  • Prostate Enlargement
  • Recurrent Urinary Tract Infections
  • Stones

To date, Dr Tan Teck Wei has been involved in more than 500 robot-assisted surgeries, building up his volume of cases from his fellowship training days and cementing his expertise in robotic surgery.

Dr Tan Teck Wei believes in the holistic management of his patients, and seeks to journey with them from diagnosis to cure.  Dr Tan is effectively bilingual in English and Mandarin, making him a popular choice with the young and old, as well as international patients.

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    • Recurrent Urinary Tract Infections
    • Blood in urination
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