Focal therapy for prostate cancer is a minimally invasive treatment that selectively targets cancerous tissue while sparing healthy parts of the prostate. This approach significantly reduces the side effects associated with radical surgery or radiation, making it an attractive option for eligible patients. However, those undergoing focal therapy should be well-informed about the recovery process, potential side effects, and long-term monitoring requirements.

Follow us on our WhatsApp channel for the latest updates: https://bit.ly/AsiaMDWhatsAppEN 

Immediate Post-Treatment Recovery

Most focal therapy procedures, including high-intensity focused ultrasound (HIFU) and irreversible electroporation (IRE), are performed on an outpatient basis, allowing patients to return home on the same day. However, the immediate post-treatment phase comes with temporary side effects and a need for careful monitoring.

Common Immediate Symptoms:

• Mild Discomfort: Some patients may experience perineal soreness, swelling, or mild pain in the treated area.
• Urinary Symptoms: Increased frequency, urgency, a weak urinary stream, or mild burning sensations during urination are common but temporary.
• Blood in Urine or Semen: Hematuria (blood in urine) or hematospermia (blood in semen) may persist for a few weeks but is generally harmless.
• Catheter Use: Some patients, particularly those treated with HIFU or IRE, may require a temporary urinary catheter for a few days to ensure proper bladder drainage.

Functional Recovery

Focal therapy aims to preserve healthy prostate tissue, reducing the risk of major functional side effects seen in more aggressive treatments like radical prostatectomy. However, some temporary changes in urinary and sexual function may still occur.

Urinary Function:

• Mild Urinary Incontinence: While rare, some patients may experience minor leakage, which usually resolves within weeks to months.
• Urinary Retention: A small percentage of patients may have difficulty emptying their bladder completely, requiring short-term urinary catheter or medications.

Sexual Function:

• Temporary Erectile Dysfunction: Although focal therapy is less likely to cause severe erectile dysfunction, some patients may experience temporary difficulties with erections. Recovery typically occurs within a few weeks to months, especially with the help of medications or rehabilitation techniques.
• Changes in Ejaculation: Some men may notice a reduced volume of ejaculate or a change in sensation, though this varies based on the extent of the treatment.

Recovery after High-Intensity Focused Ultrasound (HIFU) and Irreversible Electroporation (IRE) 

Both HIFU and IRE are advanced focal therapy techniques that target prostate cancer while minimizing damage to surrounding tissues. Each has unique recovery considerations:

HIFU Recovery

HIFU uses focused ultrasound waves to increase heat and destroy cancer cells. Post-treatment effects may include:

• Swelling and Urinary Symptoms: Due to thermal effects, some swelling of the prostate can temporarily obstruct urine flow.
• Mild Erectile Changes: While most men regain function, there may be a short-term impact on erections.
• Rectal Fistula: Though rare and uncommon, damage to the rectum may occur, especially in men who had previous pelvic surgery or radiation therapy. 

IRE Recovery

IRE, also known as NanoKnife, is a non-thermal technology that uses electrical pulses to disrupt cell membranes and destroy cancer cells. Post-procedural recovery includes:

• Lower Risk of Thermal Damage: Since IRE does not depend on heat, the risk of thermal injury to adjacent normal structures or nerves for erection will be lower.
• Mild Swelling and Discomfort: Similar to HIFU, some prostate swelling may occur but generally resolves quickly.
• Faster Recovery of Sexual and Urinary Functions: Patients undergoing IRE often report good restoration of normal functions.

Long-Term Follow-Up and Monitoring

After undergoing focal therapy for prostate cancer, medical follow-up to monitor for treatment success and detecting any recurrence are important.

Key Monitoring Steps

• PSA Testing: Prostate-specific antigen (PSA) levels are monitored every 3 to 6 months in the first few years. Lower PSA suggests successful treatment, whereas a rising PSA may indicate persistent or recurrent cancer.
• MRI prostate scan: Multiparametric MRI prostate scan is usually done about 6 months to 1 year later, in order to evaluate the treated prostate area for any signs of recurring cancer.
• Prostate Biopsy: Repeat prostate biopsy is performed by your Urologist to assess the treatment outcome.
• Symptoms Tracking: Men should report any urinary difficulties, and changes in urinary or sexual function to their doctor.

Possibility of Additional Treatments

While focal therapy for prostate cancer is an effective approach for many patients, it does not rule out the need for further interventions if cancer recurs or persists.

Options for Recurrent Cancer:

• Repeat Focal Therapy: Some patients may undergo a second session of HIFU, IRE, cryotherapy or another focal approach if cancer is detected again.
• Radiation Therapy or Surgery: In cases where focal therapy is insufficient to treat the cancer, radiotherapy or radical prostatectomy surgery may be considered.
• Active Surveillance: If the recurrent cancer is slow-growing and localized, close monitoring with regular medical follow-up may be recommended.

Lifestyle and Recovery Tips

Patients recovering from focal therapy for prostate cancer can take proactive steps to optimize their healing and overall prostate health.

Diet and Hydration:

• Increase Fluid Intake: Drinking adequate amount of water helps to flush out residual blood from the urinary tract, especially during the first few days after focal therapy.
• Anti-Inflammatory Diet: A diet rich in fresh fruits, vegetables, omega-3 fatty acids, and lean proteins supports recovery and reduces inflammation.

Pelvic Floor Exercises:

• Kegel Exercises: Strengthening pelvic muscles can improve urinary control and reduce urine leakage.
• Physical Therapy: Some men may benefit from physiotherapy to improve recovery.

Medication and Supportive Therapies:

• Pain Management: Basic pain relievers, such as paracetamol, acetaminophen or ibuprofen, can help with discomfort.
• Erectile Function Medications: Medications like sildenafil (Viagra) or tadalafil (Cialis) may assist in recovering erectile function post-treatment.
• Counseling or Support Groups: Emotional support can be helpful, particularly for men who are concerned about urinary control, sexual health or cancer recurrence.

Conclusion

Focal therapy for prostate cancer, including advanced techniques like HIFU and IRE, offers a promising treatment option with reduced side effects and faster recovery compared to radical interventions. While most patients experience a smooth recovery with minimal complications, close monitoring with medical follow-ups and proactive lifestyle adjustments are crucial for long-term success. 

This article has been fact-checked by Dr Chong Kian Tai, urologist at Surgi-TEN Specialists, Farrer Park Hospital, Singapore.