Landmark 10-Year Study Shows Focal Therapy Matches Surgery Outcomes
A major long-term study published today reveals that focal therapy—a minimally invasive treatment for prostate cancer—provides cancer control equivalent to surgery or radiotherapy while cutting the risk of debilitating side effects by more than half. The findings, drawn from nearly 3,500 men treated across the NHS over a decade, are expected to reshape clinical guidelines and expand access to the procedure.
The research, led by Imperial College London and funded by the National Institute for Health and Care Research, tracked men who received either high-intensity focused ultrasound (HIFU) or cryotherapy to destroy cancerous tissue. After ten years, only two patients had died from prostate cancer, a mortality rate comparable to traditional treatments. Crucially, rates of urinary incontinence and erectile dysfunction were less than half those reported after radical prostatectomy or radiation therapy.
Joint senior author Professor Hashim Ahmed, consultant urologist at Imperial College London and Imperial College Healthcare NHS Trust, called the results “excellent” and said they “make a compelling case for more centres to offer this treatment.” The data addresses a long-standing gap: medical regulators had previously demanded robust long-term evidence before endorsing wider adoption. With over 52,000 men diagnosed with prostate cancer annually in the UK, the potential impact is substantial.
How Focal Therapy Works
Focal therapy targets only the cancerous lesion within the prostate, sparing healthy tissue. Using real-time MRI and ultrasound guidance, clinicians deliver precise energy—either heat from ultrasound or extreme cold from cryotherapy—to ablate the tumor. The procedure is performed under general or spinal anesthesia, typically takes 90 minutes, and allows same-day discharge for most patients.
Unlike whole-gland treatments, focal therapy preserves the urethral sphincter and neurovascular bundles responsible for continence and erections. “This isn’t just about avoiding pads or pills,” explained Professor Ahmed. “It’s about maintaining quality of life for decades after treatment, especially for men diagnosed in their 50s or 60s.”
Current Access Lags Behind Evidence
Despite the therapy being available for over 20 years, only about 1,000 men receive it annually in the UK. Researchers estimate that up to 15,000 patients per year could be suitable candidates—those with a single, localized tumor that has not spread beyond the prostate gland. The treatment is not appropriate for men with multi-focal or metastatic disease.
Geographic inequality is stark. The majority of focal therapy procedures are performed in London and a handful of major teaching hospitals. Rob Huxford, diagnosed at age 44 in 2020 and treated at University College London Hospital, told the BBC he feels “incredibly fortunate” to have been offered the option. “It feels pretty unfair that this isn’t offered to men across the whole country,” he said. “It was the fact that I live in London that I was offered that treatment.”
The Access Gap
Paul Sayer, 70-year-old founder of the charity Prost8 UK, which has advocated for wider availability of focal therapy, described the study as “incredibly significant.” In an interview with the BBC, he said: “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. This research shouldn't just change clinical practice—it should change conversations in every consulting room across the UK.”
Why This Study Changes the Debate
The NHS study is the largest and longest follow-up of focal therapy ever conducted. Previous evidence relied on smaller cohorts with shorter follow-up, leading to caution from NICE and other bodies. The new data closes that evidence gap. “We now have ten-year outcomes on nearly 3,500 men treated in routine NHS practice,” said joint lead author Dr. Caroline Moore, a urologist at University College London. “This is real-world data, not a selected trial population. It reflects what happens when you roll this out beyond expert centres.”
The findings align with a broader shift toward precision oncology, where treatments are tailored to individual tumor biology rather than applying a one-size-fits-all approach. Prostate cancer is particularly suited to this paradigm because of effective imaging technologies that can pinpoint lesions with high accuracy.
Comparison to Conventional Treatments
Surgery (radical prostatectomy) and radiotherapy have cure rates above 90% for localized disease but carry significant side-effect burdens. Up to 20% of men experience persistent urinary leakage after surgery, and erectile dysfunction affects 40–70%, depending on age and nerve-sparing technique. Radiotherapy can cause bowel irritation, bladder inflammation, and delayed sexual dysfunction.
In the study, focal therapy patients reported a 6% rate of new urinary incontinence requiring pads, compared with approximately 15% in surgical cohorts. Erectile dysfunction rates were 18% versus 40–50%. Professor Ahmed noted that side effects were not eliminated—some men experienced temporary urinary retention or infection—but the severity and duration were markedly lower.
The Economic and Health System Impact
Wider adoption of focal therapy could yield significant cost savings for the NHS. A single HIFU procedure costs around £6,000–£8,000, compared with £10,000–£12,000 for robotic prostatectomy and £8,000–£10,000 for intensity-modulated radiotherapy. When factoring in reduced follow-up care, fewer incontinence products, and lower rates of erectile dysfunction treatment, the lifetime savings could be substantial.
However, upfront investment is required. The ultrasound or cryotherapy equipment costs approximately £300,000–£500,000 per centre, and training teams requires time. The study’s authors argue that the long-term benefits justify the initial spending. “We are not just treating cancer; we are trying to avoid the collateral damage that can turn a cancer survivor into a patient with chronic health problems,” said Professor Ahmed.
A Growing Movement in Global Oncology
The UK is not alone in reassessing focal therapy. In the United States, the National Comprehensive Cancer Network recently updated its guidelines to include HIFU and cryotherapy as options for selected patients. Canada and several European countries have seen steady uptake, though availability remains patchy. Japan and South Korea are investing in the technology as part of aging-population health strategies.
The study also comes amid heightened awareness of health inequalities. Men from lower socioeconomic backgrounds are more likely to be diagnosed at a later stage and less likely to receive cutting-edge treatments. Ensuring equitable access to focal therapy could help narrow that gap—if addressing geographic disparities is made a priority.
What Comes Next
NICE is expected to review its guidance on focal therapy within the next six months. The study provides the level of evidence the regulator had previously deemed insufficient. Charities and patient groups are already mobilizing to encourage rapid adoption.
Rob Huxford, now six years post-treatment without recurrence, is among those calling for change. “What I had should be standard, not a postcode lottery,” he said. “The data now proves that. There’s no more reason to hold back.”
Professor Ahmed agreed: “We have the evidence. We have the technology. The question is whether the system is ready to change the standard of care for men with prostate cancer. I believe it must.”
The hope is that within three to five years, focal therapy will be offered as a first-line option in every NHS trust with a urology cancer service. For the 15,000 men who could benefit each year, that change cannot come soon enough.
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