Focal Therapy for Prostate Cancer

by Dr. Chong Kian Tai
07 Dec 2019

Prostate cancer is the third most common cancer affecting men in Singapore. The majority of men with prostate cancer do not have urinary problems or pain.

They are diagnosed through an abnormal result in the prostate-specific antigen (PSA) blood test and a subsequent prostate biopsy that shows cancer cells.

Fortunately, most patients with prostate cancer are diagnosed in its early stages. The cancer cells are still localized within the prostate gland and have not spread to other parts of the body.

However, several existing options to treat localized prostate cancer, including da Vinci robotic-assisted radical prostatectomy and primary radiotherapy, may cause life-changing side effects.

In Singapore, the da Vinci robotic-assisted radical prostatectomy is commonly done to remove the entire prostate gland by surgery. After undergoing this major surgery, every patient will have varying degree of erectile dysfunction and start to wear diapers because of urinary incontinence.

These problems will gradually improve over months or even years. Unfortunately, some patients do not recover fully.

With radiotherapy, some patients may have urinary frequency and wake up more often at night to pass urine. Occasionally there may be painful urination or blood in the urine or stools that affect daily activities.


Focal Therapy of Prostrate Cancer

Focal therapy uses strong energy that is concentrated to destroy its specific targets. One of the energy sources is high-intensity focused ultrasound (HIFU), which has been tested and approved for accurate and effective treatment of localized prostate cancer.

During the HIFU procedure, there is no radiation, cutting or surgical scars.

Since focal therapy using HIFU only affects the selected areas of the prostate, there is less chance of urinary incontinence and less chance of damaging the nerves for penile erection.

A multicenter research study on this technique with five-year outcomes in United Kingdom was published in 2018 in the prestigious European Urology medical journal. The results showed that 100 per cent of all patients are alive, nobody uses more than one pad per day, and only two out of every 100 patients (2 per cent) use diaper pads for urinary incontinence.


Focal One

The Focal One device is the robotic HIFU machine that was approved by U.S. Food and Drug Administration in June 2018 and subsequently by Health Sciences Authority in Singapore. It uses the latest technology for precise treatment of specific prostate tissues without damaging non-target areas.

Focal One also has capabilities for MRI-ultrasound fusion image processing, precision targeting with robotic-assisted control, safety features to prevent overheating of rectal wall, and the ability to check for adequate treatment using ultrasound and contrast-enhanced microbubbles.

Prostate cancer patients who may be suitable for this procedure include those newly diagnosed with prostate cancer that is localized within the prostate gland, and those with prostate cancer that recurred after previous radiotherapy.

Focal One is available in Singapore for focal therapy of prostate cancer. It can be performed as a day surgery procedure.

Many patients can be discharged from the hospital on the same day after completing robotic HIFU treatment.

Dr. Chong Kian Tai is a urologist with PanAsia Surgery at Mount Elizabeth Novena Specialist Centre (Singapore), and Surgi-TEN Specialists, Farrer Park Hospital (Singapore)