Focal therapy for prostate cancer may match surgery or radiotherapy while causing fewer side effects, a major study suggests.
The less invasive treatment uses high-intensity ultrasound or freezing cryotherapy to destroy cancerous tissue.
The 10-year NHS study, led by Imperial College London, followed nearly 3,500 men who received the therapy, providing long-term data that medical regulators had previously said was missing.
Researchers described the results as “excellent” and said they were likely to increase pressure for focal therapy to be made more widely available.
Nearly all the men in the study had intermediate or high-risk prostate cancer, but 10 years after treatment only two had died from the disease.
The outcomes were reported to be as good as surgery or radiotherapy, while carrying less than half the risk of side effects such as urine leakage or loss of sexual function.
Joint senior author professor Hashim Ahmed, consultant urologist at Imperial College London and Imperial College Healthcare NHS Trust, said the findings demonstrated that “focal therapy delivers excellent long-term cancer control across a broad range of patients”.
“It makes a compelling case for more centres to offer this treatment,” he added.
Focal therapy was introduced more than 20 years ago, but only about 1,000 men a year in the UK currently receive it, despite up to 15,000 potentially being eligible.
The treatment is not suitable for men whose cancer is in several areas of the prostate or has spread beyond the gland.
A key reason focal therapy has not been used more widely is concern about long-term survival and whether treating only part of the prostate might lead to higher recurrence.
The study, supported by the National Institute for Health and Care Research, suggests those concerns may be largely unfounded.
However, NICE, the health regulator that assesses whether treatments should be used routinely in the NHS, has not approved focal therapy as a routine treatment, largely because long-term evidence has been limited.
This means hospitals are not obliged to offer it to patients.
Routine access on the NHS is currently limited to 10 centres in England, with none elsewhere in the UK, a situation prostate cancer campaigners have condemned as a “postcode lottery”.
Last month, the government committed up to £2.8m to expand focal therapy provision in England by creating several new centres.
Health innovation and safety minister Preet Kaur Gill said: “Our National Cancer Plan sets out our ambition to transform cancer care, and backing innovations like focal therapy is exactly how we are delivering on that promise.”
The charity Prostate Cancer UK said focal therapy “could help thousands of men each year avoid unnecessary side-effects” and called on NICE to review the evidence.
Amy Rylance, from the charity, said: “Side effects like incontinence or sexual problems can be devastating, and this is the first long-term study that shows many men could avoid them without increasing the risk their cancer could return.
“And it’s not just important for individual men. These serious side effects are a major reason we don’t yet screen for prostate cancer and reducing them makes it far more likely we can get to a screening programme for all men sooner.”
A £60m trial is examining how targeted prostate cancer screening could be introduced by combining rapid MRI scans with treatments that may cause less harm, such as focal therapy.
MRI, or magnetic resonance imaging, uses powerful magnets and radio waves to create detailed images of the inside of the body.
All men diagnosed with prostate cancer as part of the Transform screening study will be offered focal therapy if it is appropriate for their disease.
One barrier to a national prostate screening programme has been concern that it could lead to more harm than good because of the side effects of treatment.
Researchers say the latest focal therapy findings could be another key piece of evidence that may help lead to a screening programme in years to come.
Dr Alastair Lamb, clinical reader at Barts Cancer Institute, St Bartholomew’s Hospital, said: “It’s an exciting potential treatment.
“We need randomised trials. We need better understanding of localised prostate cancer, how it arises, how it grows and how it spreads.
“We eagerly await the results of the PART Trial, the first and only large randomised controlled trial comparing focal versus radical therapy in prostate cancer that needs treatment – until then focal therapy remains a very promising experimental treatment.”
