Fox Chase Cancer Center

Focal Therapy for Prostate Cancer

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At Fox Chase Cancer Center, we strive to offer more advanced and less invasive procedures in the treatment of prostate cancer. Focal therapy is an emerging technique for men with small, localized prostate tumors. Using this technique, the region with prostate cancer is specifically targeted, sparing normal surrounding tissue from damage.

By focusing on treatment specifically to small tumors within the prostate, the normal portion of the prostate gland and surrounding structures are spared from unnecessary therapy and the usual side effects associated with traditional whole prostate treatments.

When appropriate, this limited and targeted treatment can be a great alternative to standard surgery or radiation therapy for eligible prostate cancer patients because it offers key benefits:

  • Fewer side effects and minimal negative impact on urinary, bowel, and sexual function
  • Fast recovery time
  • Minimal blood loss

Eligibility

The prostate cancer team at Fox Chase is commonly able to confirm the location of a man’s cancer with a high degree of certainty, using some of the latest diagnostic techniques, such as multiparametric MRI scans, MRI-ultrasound fusion targeted biopsy and transperineal mapping biopsies. These diagnostic methods allow our doctors to determine whether or not a man is eligible for focal therapy.

Focal therapy is available to:

  • Men with a small, intermediate-risk prostate tumor that is localized within a limited region of the prostate gland, where preserving function is a specifically high priority
  • Men who want to preserve sexual function and urinary continence

Details of the Procedure

Focal therapy is performed in an outpatient setting under general anesthesia. During the procedure, the target zone of prostate treatment is carefully planned and confirmed in real-time, using transrectal ultrasound guidance. Therapy is closely monitored to avoid unneeded treatment beyond the target area of cancer, minimizing any impact to the adjacent normal prostate and surrounding structures, which can greatly reduce the side effects of therapy. 

Importantly, our doctors can customize treatments to each patient when we have a precise understanding of the tumor location in the prostate.

Focal therapy is an umbrella term that describes partial prostate gland treatment, which is often performed using different treatment technology–the most common applied are cryoablation or High Intensity Focused Ultrasound (HIFU).

Cryoablation

With this approach, a needle probe is directed into the target area, to result in supercooling of the region. A small area surrounding the probe will freeze, which leads to the controlled destruction of prostate tissue. As a focal treatment, cryoablation usually causes fewer side effects than traditional cryoablation therapy that is applied to treat and freeze the entire prostate gland.

High Intensity Focused Ultrasound (HIFU)

In contrast, HIFU uses high intensity sound waves to create a zone of heating, which similarly can lead to tissue destruction. HIFU is a newer treatment approach, first FDA approved for use in the US in December 2015, and it remains an investigational treatment for prostate cancer. The prostate cancer team has unique experience with HIFU therapy, having been involved in the initial clinical trials of the device; few urologists nationally have the expertise with HIFU equal to the prostate cancer specialists at Fox Chase.

Potential Side Effects

As with any treatment for prostate cancer, side effects also may occur after focal therapy, depending on where the tumor is located and the region of the prostate receiving treatment.

Common anticipated side effects include:

  • Minor swelling
  • Localized soreness or discomfort. 
  • Very minimal change, if any, to urinary, bowel and sexual function 

Source: Fox Chase Cancer Center

Fox Chase Cancer Center Researchers Open Clinical Trial That Could Help Men Avoid Surgery to Remove Prostate

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Andres Correa, MD, has begun recruiting for a clinical trial called PRESERVE that will evaluate the safety and efficacy of the NanoKnife System to treat patients with intermediate-risk prostate cancer
Dr. Andrew Correa, assistant professor in the Department of Urology, one of the head clinicians of the trial.

PHILADELPHIA (February 22, 2023)—Researchers at Fox Chase Cancer Center have begun recruiting for a clinical trial called PRESERVE that will evaluate the safety and efficacy of the NanoKnife System to destroy prostate cancer cells. One of the measurements of treatment effectiveness is to assess the number of subjects that were able to avoid surgery to completely remove the prostate.

NanoKnife is a focal therapy, a form of treatment that is typically considered less invasive and that can eliminate cancer cells through different forms of energy such as heat and cold, all while sparing normal cells.

“I think this technology is the future, and I’m hoping that in 10 to 15 years I’ll be doing surgery to remove the prostate in a very limited number of patients. Those types of procedures really affect a patient’s quality of life, and if we can avoid that it would be ideal,” said Andres Correa, MD, an assistant professor in the Department of Urology and one of the clinicians heading the trial.

“NanoKnife is a technology that uses electricity to create a very high voltage between two probes. The lesion that has been identified and biopsied beforehand is placed between these probes and the electricity disrupts the integrity of cells, what we call the cell membrane. That’s how the cancer is affected,” he said.

PRESERVE, which stands for Pivotal Study of the NanoKnife System for the Ablation of Prostate Tissue, is being conducted with several other sites in the United States, but Fox Chase is the only site in Pennsylvania.

Participation in the NanoKnife research study would be an addition to the two types of focal therapy that Fox Chase already offers to treat prostate cancer. The first of these is cryoablation, in which a needle probe is used to freeze and kill diseased prostate tissue. The second is high-intensity focused ultrasound, which uses sound waves to create heat that destroys diseased tissue.

For the new study, researchers are recruiting up to 118 subjects who will be treated with NanoKnife and standard care. They will be observed closely through prostate specific antigen (PSA) scores, MRIs, and biopsies for 12 months and will be followed for up to five years to monitor whether cancer returns after treatment. Correa will be conducting the Fox Chase arm of the trial with David Chen, MD, FACS, a professor in the Department of Surgical Oncology.

Chen said that historically prostate cancer has been overtreated, often favoring aggressive therapies like surgery or radiation for individuals who may not necessarily need them. With the PRESERVE trial, they hope to provide conclusive evidence that the NanoKnife System is best suited for these “in-between” patients.

“This technology fills a role for men who may need some treatment but for whom the traditional treatment is probably too much and can cause worse side effects or possible complications. It’s an intermediate step that allows us to do something about the cancer while not subjecting these men to the same sort of radical treatment that we historically felt was needed,” said Chen.

“We’re excited about the expected role of NanoKnife in this application, and we recognize that there are probably other types of devices that may come in the future,” he said.

Correa added that the PRESERVE trial will also help researchers and clinicians better understand how therapies will evolve over time and impact cancer recurrences and quality of life.