Targeted prostate cancer treatment cuts risk of side effects, study suggests

Targeted prostate cancer treatment cuts risk of side effects, study suggests

By

Medical editor

A less invasive therapy for prostate cancer is just as effective as surgery or radiotherapy but with a lower risk of side effects, a major study suggests.

The treatment, named focal therapy, uses high-intensity ultrasound or freezing cryotherapy to destroy cancerous tissue.

A 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 say the results are "excellent" and they are likely to add to pressure for focal therapy to be made more widely available.

Research could 'change conversations'

Nearly all the men had intermediate or high-risk prostate cancer - but 10 years after treatment only two had died from the disease.

These outcomes are as good as surgery or radiotherapy, but with 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 at present only about 1,000 men a year in the UK receive it - despite there being up to 15,000 who could benefit.

The therapy is not suitable for men whose cancer is in multiple parts of their prostate or has spread beyond the gland.

Rob Huxford was diagnosed with prostate cancer in 2020 when he was 44.

He says he feels "incredibly fortunate" his doctor offered him focal therapy.

"My outcomes have been fantastic," he says. "I have no long-term issues at all and it feels pretty unfair that this isn't offered to men across the whole country. It was the fact that I live in London that I was offered that treatment."

Paul Sayer, 70, founder of charity Prost8 UK, has also benefited from focal therapy and says this new study is incredibly significant.

"Our hope is that this evidence marks the point where every suitable man is routinely offered focal therapy as part of his treatment choices, regardless of where he lives," he tells the BBC.

"This research shouldn't just change clinical practice - it should change conversations in every consulting room across the UK."

So why has it been so little used?

A key reason the therapy has not been rolled out more widely to date is concern about long-term survival and whether treating only part of the prostate might lead to higher recurrence.

This study suggests these fears are largely unfounded, but the health regulator NICE has not approved focal therapy as a routine treatment largely because long-term evidence has been limited.

In turn this means hospitals are not obliged to offer it to patients.

As a result, routine access on the NHS is 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 £2.8 million to expand focal therapy provision in England, 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.

"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," Amy Rylance from the charity says.

"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. "

Hope for future screening programme

Several high-profile celebrities have revealed they have prostate cancer, including Olympic cycling legend Sir Chris Hoy who has said publicly he has terminal prostate cancer.

Former Prime Minister Lord Cameron revealed last year that he had been treated for prostate cancer using focal therapy, saying it was "not right" that many men do not have access to the treatment.

TV presenter Jeremy Clarkson, who is now in remission, also had focal therapy.

All men diagnosed with prostate cancer as part of the 'Transform' screening study will be offered focal therapy, if appropriate, to treat their disease.

The £60 million trial is looking at the best way to introduce targeted prostate cancer screening by combining rapid MRI scans with treatments that cause lower harm, such as focal therapy.

This latest study, published in the journal European Urology, is another key piece of the jigsaw, which could help lead to a national prostate cancer screening programme in years to come.

Prostate cancer is the most common cancer in men in the UK - more than 64,000 are diagnosed each year, and about 12,000 die from the disease.