From August 2015 Journal of Urology:  Study by New York University in which images from mpMRI identified prostate cancer before radical prostatectomy.  The pathologists then took the gland and did step-sections to pinpoint the actual tumor.  They found that a 9 mm “halo” of treatment around the imaged tumor boundaries would have covered 100% of the cancers.  Not 80%, not 90%, but 100%.

The criticism of focal therapy has been the concern that the mpMRI images did not designate the entire tumor, thereby risking leaving some of the tumor untreated if only the imaged area was treated with HIFU.  Since HIFU treats in 3 mm shots, adding 3 shots around the imaged tumor boundaries should cover the entire lesion.

Focal HIFU therapy spares non-cancerous prostate tissue, and the incidence of side effects (ED, Incontinence, Scar Tissue) was no different from “sham” operation in a study from University Central London.  The 5 year cancer free statistics were excellent.  The concept of focal therapy is foreign to physicians who only offer surgery or radiation, but in appropriate patients, it is a very attractive choice.  A mpMRI is mandatory to ascertain significant lesions are not missed, and not all communities have facilities for this study.