A minimally invasive treatment that targets only the cancerous part of the prostate has shown it can keep men cancer free for a decade, while dramatically reducing the risk of life altering side effects. The largest and longest study of its kind, tracking nearly 3,500 men over 20 years, found that only two patients died from prostate cancer within ten years of receiving focal therapy.
Prostate cancer is the most common cancer in men, with more than 60,000 new cases each year in the UK alone. For localised disease, standard options have long been radical prostatectomy or whole prostate radiotherapy. Both are effective but carry significant risks of urinary incontinence and erectile dysfunction. These harms are a key reason the National Screening Committee recently advised against screening all men. Focal therapy changes that equation. By destroying only the tumour while sparing healthy tissue and surrounding nerves, it leads to a five fold lower risk of such side effects. The study, published in European Urology, shows that this precision approach works not only for low risk cancers but also for more aggressive disease that would previously have ruled out the option.
Researchers from Imperial College London and Imperial College Healthcare NHS Trust worked with 14 hospitals across the UK to follow 3,477 men treated between 2004 and 2024. Patients received either heat based high intensity focused ultrasound (HIFU) or freezing based cryotherapy. The results showed that focal therapy effectively controlled prostate cancer across a broad range of patients, matching the long term mortality rates of surgery and radiotherapy. Currently, only about 1,000 men per year receive focal therapy in the UK, yet up to 15,000 could be suitable. Awareness has risen sharply after several public figures spoke about undergoing the treatment, and it is already approved by the NICE HealthTech programme for centres that collect outcome data in national registries.
What This Means for Patients and the Future of Screening
The findings strengthen the case for making focal therapy a routine first line choice. Study author Dr Alexander Light, NIHR Doctoral Fellow at Imperial College London, called the results “really encouraging,” noting that many men with more aggressive disease who would traditionally have been told focal therapy was not an option can now benefit. Joint senior author Professor Hashim Ahmed, who leads the TRANSFORM screening study, said the evidence “makes a compelling case for more centres to offer this treatment.” He welcomed the government’s announcement of £2.8 million in capital funding to expand focal therapy in line with the TRANSFORM trial across the UK.
Paul Sayer, founder of the charity Prost8 UK, who has undergone focal therapy himself, said the study shows that many men do not have to choose between curing their cancer and preserving their quality of life. “Every man deserves to know all of his appropriate treatment options before making one of the biggest decisions of his life,” he said. Amy Rylance, Director of Health Services at Prostate Cancer UK, called it “truly fantastic news,” adding that reducing side effects makes it far more likely that a screening programme for all men can be achieved sooner. The next step is for clinicians and patients to use this long term evidence to update national guidelines, so that focal therapy is routinely offered as a first line choice for suitable men across the UK.