Focal Therapy (HIFU, VTP, Cryotherapy, Tulsa) Study anyone? ...anyone?

Posted by K. J. HOLZ @kjholz, May 16 10:43am

Had to Google what VTP is: "Vascular-targeted photodynamic therapy (VTP) is an approved treatment option for unilateral low-risk prostate cancer (PCa)."

So. Is it just me or?... From the paper:

"ISUP grade distribution was 58% grade 1, 29% grade 2, and 13% grade ≥3. Treatment modalities comprised HIFU (43%), VTP (35%), cryotherapy (12%), and TULSA (10%)."

(I've concluded it's Them, not me)

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Jeff Marchi | @jeffmarc | May 16 11:34am

Here’s some feedback from a doctor at UCSF about focal therapy.

At the 11/1/2025 PCRI conference the following was said by Matthew R. Cooperberg, MD, MPH Urologic Oncologist UCSF

What about focal therapy?
* The energy modality matters much less than the accuracy of the imaging - which is not there yet.
* Overall focal therapy is associated with minor side effects, but high rates of recurrence both in- and out-of-field.
* Focal therapy is not really a replacement for surgery or radiation; it is better considered an adjunct to active surveillance

Af the UCSF prostate cancer forum on 4-17-26 Dr. Cooperberg had slides with this information

UCSF Results: first 135 HIFU patients
 • 54% recurrence (41% in-field) 
• 4% progression by 1 year, 16% overall
 • IPSS (urinary obstruction) 6 before, 6 after 
• SHIM (erection function) 16 before, 13 after (p=0.11)
 • Major drivers of recurrence: GG3, high Decipher

Trade-offs
 • Overall focal therapy is associated with minor side effects, but high rates of recurrence
 • Inadequate energy delivery? 
• Inadequate field of treatment? 
• New cancer development? 
• Others? 
• Understanding the high recurrence rates and trying to improve them is a major area of research focus.
 • Focal therapy does not burn bridges: RP, RT, even additional focal therapy are possible if necessary

Summary thoughts 
•Focal ablation has a growing role for very carefully selected cases. 
• Side effects rates are low but recurrence rates are high. GG3 and high Decipher are warning signs, as are high PSAD and bilateral disease. 
• Focal therapy is an adjunct to active surveillance; additional treatment may well be needed down the road, but these treatments are still possible after focal.

University of California Consensus 
1 Focal therapy must be acknowledged to be investigational 
2. Focal therapy should be done under trial or research protocols as much as possible 
3. Candidates should have at least 10 year life expectancy, GG2 or low-volume GG3, stage T1 or 2, and PSA < 10 or PSA < 20 and PSAD < 0.15 
4. Candidates need an MRI-guided confirmatory biopsy before treatment 
5. Follow-up biopsy at 12 months is essential

K. J. HOLZ | @kjholz | May 16 3:04pm

In reply to @jeffmarc "Here’s some feedback from a doctor at UCSF about focal therapy. At the 11/1/2025 PCRI conference..." + (show)

@jeffmarc

Here’s some feedback from a doctor at UCSF about focal therapy.

At the 11/1/2025 PCRI conference the following was said by Matthew R. Cooperberg, MD, MPH Urologic Oncologist UCSF

Af the UCSF prostate cancer forum on 4-17-26 Dr. Cooperberg had slides with this information

Jump to this post

@jeffmarc Thanks for the UCSF results.

Just want to get back to the German study and "ISUP grade distribution was 58% grade 1, 29% grade 2, and 13% grade ≥3. Treatment modalities comprised HIFU (43%), VTP (35%), cryotherapy (12%), and TULSA (10%)."

58% of this focal therapy study were Gleason 3+3 (Grade Group 1).

Paper goes on to report "After a median follow-up of 1.73 years, 40% of patients developed recurrence and 15% showed histologic progression."

Good thing the study included 58% Grade Group 1s in there to lower those recurrence scores.... 🙄

K. J. HOLZ | @kjholz | May 16 3:24pm

In reply to @jeffmarc "Here’s some feedback from a doctor at UCSF about focal therapy. At the 11/1/2025 PCRI conference..." + (show)

@jeffmarc

Here’s some feedback from a doctor at UCSF about focal therapy.

At the 11/1/2025 PCRI conference the following was said by Matthew R. Cooperberg, MD, MPH Urologic Oncologist UCSF

Af the UCSF prostate cancer forum on 4-17-26 Dr. Cooperberg had slides with this information

Jump to this post

@jeffmarc Hi again. Just some context for that USCF study of USCF's first 135 HIFU patients:

"For the study, the investigators conducted a retrospective review of 135 men who underwent a HIFU procedure at UCSF between 2021 to 2023"

"The authors also added, 'Notably, we found no significant differences in biopsy outcomes between cases treated early at our institution and later, showing no identifiable learning curve with the FocalOne device.'”

So I researched "FocalOne device" and USCF. They still use FocalOne ---BUT.

"Recent Advancements: In early 2025, UCSF made headlines as the first center worldwide to integrate advanced Restriction Spectrum Imaging (RSI) MRI software (OnQ Prostate) with the Focal One HIFU system for even more precise lesion targeting."

"advanced Restriction Spectrum Imaging (RSI) MRI software (OnQ Prostate)" that the 2021-2023 HIFU-135 missed out on...

Same appears to be happening with Tulsa Pro. As of this week, I read they're going "to explore the potential of integrating TULSA-PRO with PSMA PET molecular imaging technologies to enhance ablation planning and monitoring".

The Better To See You With, I guess....

Cheers.

brianjarvis | @brianjarvis | 6 days ago

Are you in the U.S. or in another country?

I’ve read that VTP is not an FDA-approved treatment for prostate cancer in the U.S. While VTP is approved for use in certain European and Latin American countries, the FDA declined to approve it for localized prostate cancer.

You may want to look into that.

K. J. HOLZ | @kjholz | 6 days ago

Hi Brian. Thank you, no, not in the U.S. and never heard of VTP prior to reading about this German study comparing HIFU, VTP, Cryotherapy, and TULSA".

Still gob-smacked that 58% of those treated were Grade Group 1!