Focal therapy for early-stage prostate cancer
Prostate cancer has just leap-frogged to become the second most common cancer in men in Singapore, overtaking lung cancer in the 2014-2018 Singapore Cancer Registry report published in March 2021. Unfortunately, majority of men with prostate cancer do not have urinary problems.
Based on published data from the Singapore Cancer Registry 50th Anniversary Monograph (1968 – 2017), a whopping 30.7 per cent of Singapore men already have terminal Stage 4 prostate cancer in 2017 when they were first diagnosed. Only 51 per cent of Singapore men were diagnosed with early Stage 1 or Stage 2 prostate cancers that are potentially curable.
In the US, the number of late-stage prostate cancer has also increased and doubled between 2003 and 2017, going from 4 per cent to 8 per cent, according to the U.S. Centers for Disease Control and Prevention (CDC) morbidity and mortality weekly report in Oct 2020. Top prostate cancer experts like Dr. Anthony D’Amico at Harvard Medical School in Boston said this increase was an inevitable consequence after the US Preventive Services Task Force in 2012 did not recommend the routine use of prostate cancer screening with the prostate-specific antigen (PSA) test.
Since most men with prostate cancer feel well without urinary problems, it is best for every man above 50 years old to know their prostate specific antigen (PSA) level. Many men are diagnosed with prostate cancer due to abnormal PSA blood test results and prostate biopsies that show cancer cells.
How can we treat early-stage prostate cancer?
When prostate cancer is diagnosed in its early stages, these cancer cells are still localized within the prostate gland and have not spread to other parts of the body. However, existing standardof-care treatment options to treat localized early-stage prostate cancer, including da Vinci® robotic radical prostatectomy surgery and primary radiotherapy, may cause life-changing side effects.
In Singapore, the da Vinci® robotic radical prostatectomy is commonly done to remove the entire prostate gland by surgery. After this major surgery, every patient will start to wear diapers because of urinary incontinence. Many men will also have impotence and erectile dysfunction. These side effects and complications will gradually improve over months or even years, but, unfortunately, some patients do not recover fully.
After radiotherapy treatment, some patients may have frequent urination, wake up more often at night to pass urine, painful urination, or have bloody urine or stool that affects daily activities.
What is Focal Therapy for prostate cancer?
Another option to treat early-stage prostate cancer is focal therapy. It uses a strong energy source that is concentrated to destroy specific targets. The common energy sources available are cryotherapy and high intensity focused ultrasound (HIFU), which have been tested in international clinical research for accurate and effective treatment of cancer areas within the prostate gland.
For HIFU treatment of prostate cancer, there is no radiation, no cutting and no surgical scars. This results in quicker recovery and minimal bleeding.
Advantages of Focal Therapy for prostate cancer using HIFU
Most men do not like to wear diapers or become impotent with erectile dysfunction after prostate cancer treatment.
Since focal therapy using HIFU only treats the affected cancer areas of the prostate, there is less chance of urinary incontinence and less chance of damaging the nerves for penile erection.
A multicentre research study with 5 years of clinical research outcome in United Kingdom was published in 2018 in the prestigious European Urology medical journal. Their results showed that 100 per cent of all patients were alive, and 98 per cent did not have urinary incontinence.
What is Focal One® HIFU device?
Focal One® HIFU device is the robotic HIFU machine that was approved by the US Food and Drug Administration (FDA) in June 2018 and subsequently by the Health Sciences Authority (HSA) in Singapore. This is the latest version of several HIFU machines made by EDAP TMS, which is a French company that developed ultrasound HIFU treatment for prostate cancer for almost 30 years.
This device is EDAP TMS’s most advanced device with the latest technology for precise treatment of specific prostate tissues, without damaging non-target areas. Focal One® HIFU device has capabilities for MRI-ultrasound fusion image processing, precision targeting with robotic-assisted control, safety features to prevent overheating of rectal wall, and also the ability to check for adequate treatment using ultrasound and contrast-enhanced microbubbles.
Using Focal One® HIFU to do focal therapy for prostate cancer is available in Singapore. Currently, this is the first and only machine available in Southeast Asia. In Singapore, from May 2021, the use of HIFU to treat prostate cancer is under the Ministry of Health’s constrained-use framework which requires patients to pay their own treatment fees.
Who is suitable for Focal Therapy?
Prostate cancer patients who may be suitable include newly diagnosed prostate cancer that is localized within the prostate gland, and prostate cancer that recurred after previous radiotherapy.
Focal therapy of prostate cancer using the Focal One® HIFU machine can be done as a day surgery procedure. Some patients can be discharged from the hospital on the same day, while the rest may prefer to go home after an overnight stay.