Half of Prostate Cancer Focal Therapy Cases Were Inappropriate

If anybody is considering focal therapy - new analysis showed that about half of all cases treated with focal therapy were actually NOT good candidates for focal therapy.

It seems the chief complaint is that those with low risk (Gleason 6) are getting focal therapy. Better than getting RP or RT for those unwilling to do AS. Showed a decrease of over 50% in high risk and 70% in very high risk patients getting focal therapy.

And on the other hand, it was used in high and very-high risk cases, where it's more likely that there's undetected cancer outside the area being treated. As the article mentioned, the main issue right now is that there's not enough hard data to show where it is or isn't appropriate.

This also highlights the ongoing dilemma:

More-focussed treatment: lower risk of side-effects, higher risk of missing some undetected cancer spread

Less-focussed treatment: higher risk of side-effects, lower risk of missing some undetected cancer spread

Unfortunately, life doesn't hand out many freebies. 😟

It seems that the best candidate is a patient with intermediate favorable PC. Treating lower risk patents is "overkill" and higher risk is "underkill". Many practitioners jumped on opportunity to treat much broader scope of patients and as article highlighted - what is appropriate in clinical trial does not automatically translates to clinical practice without collecting long term data and analyzing the "real life" results.

How do I get a specific chemotherapy recommendation or a straight answer that my case is futile and that I should enter a palliative care program? I know from past experience with dying relatives that physicians particularly are reluctant to give straight answers.

@johnn01
I am so sorry to hear that John : (( - can you tell us more about yourself and perhaps start a new thread so that all members can see your question : (.
Are you located in the USA ?
What particular area of the USA ?
Some members here can give you direction of where to go to get the best possible care and the best advice and also the names of the best doctors and hospitals in your area.
I do not know what is your stage or extent of your PC but try not to dismiss any of the treatments : ( since many are very, very successful regardless of the grade and stage !
I am glad that you found this place since you will now get support and a lot of new and helpful information 🍀 - please keep us posted and I am wishing you healing and the best of luck in your future treatments ✨

Seems as long as it is confined to the prostate and they can reach it, and it needs treatment, so called focal therapy (which can be up to 90%+ of prostate) are the BEST option. All that overgrading and super push to over-treat is out there, I am sure 3/4 of the pathology I had are plain wrong and were over graded. I am sure 3/4 of the recommendations for treatments I had were over-treatment. Seems the field is geared around that, and up to patient to catch it and only do what is needed. But to go after focal is not the place to start. Most places in the country may have teams that treat PCa but they have zero focal treatment available in hundreds of miles so they feel over-treatment is justified and never mention anything but overtreatment. The one doctor in my area who supposedly does focal treatments was only doing it in very rare cases and he routinely goes for over treatment recomendations because he makes more money that way. The place to start is not going after focal places, every day practices never mention anything but over-treatment prostatectomies or radiation with ADT, based on over-grading and making money. Plus pathology is real bad in my opinion, almost all out there is over-grading to cover in case of legal action, maybe these are better targets to go after.

@johnn01 I'm sorry you're in This situation, John.

The challenge with advanced-stage prostate or breast cancer, unlike most other cancers, is that there *is* no straight answer.

There is a plethora of new treatments for metastatic prostate cancer, and there is a chance that many of us can be kept alive indefinitely now, so that stage-4 cancer becomes more of a chronic disease we live with than a terminal disease we die of.

Obviously, a lot of it depends on your specific situation, but there are people here in the forum who have been alive (and thriving) with stage 4 prostate cancer for many years, some of whom have had chemo and some of whom have had other treatments.

I was diagnosed with stage 4b prostate cancer in 2021 when I was 56. Since I had only one metastasis, I had metastasis-directed therapy (surgery and radiation) rather than chemotherapy, but it's a similar idea. I've also been on ADT and Apalutamide continuously since 2021.

After 5 years, I'm in deep remission and I'm living a pretty normal life. In 2021 they told me I'd have 3–5 years; now they tell me to think about old age. That's how fast things changed.

Back in 2020 when I was looking for treatment for my 3+4=7, I was not a candidate for focal therapy due to having lesions in both sides of my prostate. (I wound up getting proton radiation treatments.)

@brianjarvis

Yes, there are many limitations beside gleason and grade.

People also need to understand that many local therapies treat just that part of the gland and whatever is left can become cancerous over time. That was one of the reasons why we did not even consider having a focal therapy. Not to mention that after RP gleason was upgraded BIG time so luckily we did not have "focal" treatment, god forbid 😬.

Also, for TULSA lesion has to be close to the urethra for heat to work ! My husband's lesion was on outer side of the gland and close to apex and TULSA would not be effective at all.

Every treatment has its pluses and minuses - there is just NO silver bullet nor "better" treatment per se.