Dr Olivares on the Functional Advantages of Focal Therapy in Prostate Cancer

Ruben Olivares, MD, urologic surgeon, associate professor, Urology, Glickman Urological Institute, Cleveland Clinic, discusses the functional advantages of using focal therapy over localized radiation in prostate cancer, as well as the use of failure-free survival (FFS) as a surrogate end point for evaluating survival outcomes with this approach.

The primary distinction between localized radiation and focal therapy for prostate cancer lies in the guidance used to deliver the treatment, Olivares begins. Focal therapy employs advanced fusion imaging capabilities that provide precise anatomical guidance, allowing for the targeted delivery of energy to specific areas of the prostate, he explains. This method enables clinicians to accurately map the area that will be affected by the energy, using probes or needles to delineate the outer layer of energy reach, Olivares adds.

Clinical data suggest that focal therapy has favorable functional outcomes, particularly in terms of minimizing the risk of erectile dysfunction and urinary incontinence, despite the use of high-energy modalities, he continues. These outcomes are especially relevant when considering the treatment’s impact on quality of life. However, to comprehensively evaluate the effectiveness of focal therapy, long-term oncological outcomes such as overall survival (OS) are crucial, Olivares emphasizes.

Prostate cancer is characterized by its slow progression, making it challenging to obtain OS data within a short timeframe, he notes. The disease's indolent nature means that it may take 30 to 40 years of follow-up to gather reliable OS data for patients undergoing focal therapy, Olivares states. As a result, researchers currently rely on alternative end points such as FFS and metastasis-free survival (MFS) to assess the efficacy of focal treatments.

FFS measures the time during which a patient remains free from treatment failure, while MFS tracks the period without the development of metastasis, Olivares clarifies. Both metrics are increasingly accepted as surrogate end points for OS, given their correlation with long-term outcomes. Evidence from other slow-growing tumors suggests that FFS and MFS may be reliable indicators of OS, providing a promising outlook for the continued use of focal therapy in managing prostate cancer, he concludes.