Focal Therapy for Prostate Cancer: Targeting the Tumor

The idea sounds appealing.

1. Find the cancer.
2. Target it.
3. Destroy it.
4. Avoid surgery. Avoid radiation. Move on with your life.

This promise is driving interest in focal therapies for prostate cancer. Procedures like TULSA and HIFU are marketed as modern, precise, and less harmful alternatives to prostatectomy or radiation.

But according to Dr. Stephen Petteruti, the science behind focal therapy raises serious questions that most men are never told to ask.

Prostate cancer does not behave like a skin lesion.
It does not grow in a clean, isolated spot.
And it does not respect tidy boundaries on MRI scans.

The assumption behind focal therapy is called the “index lesion theory.” The idea is that prostate cancer starts in one dominant area and spreads outward. Treat that spot, and you solve the problem.

Dr. Petteruti explains why this theory fails at the cellular level.

Cancer spreads microscopically, long before it shows up clearly on imaging. By the time a lesion appears on MRI, cancer cells may already be distributed throughout the gland or beyond it. Destroying tissue does not equal stopping disease progression.

That distinction matters.

In clinical studies, focal therapies often succeed at lowering PSA and shrinking prostate tissue. But lowering a number is not the same as preventing metastasis or improving survival. Short-term success does not equal long-term protection.

The studies most often cited follow patients for one year. Sometimes two. Prostate cancer evolves over decades.

That gap is where men get misled.

Focal therapies are also not benign. Erectile dysfunction still occurs. Residual cancer is common. And many procedures require a biopsy first, introducing risks that cannot be undone.

Dr. Petteruti does not dismiss focal therapy outright. He explains where it might have a role, what conditions would need to change, and why systemic immune support matters more than localized destruction.

He also addresses the uncomfortable truth about medical economics, FDA clearance, and why new devices spread faster than long-term data.

If you are considering focal therapy for prostate cancer, or if someone has told you it is the “safe middle ground,” you need this information.

The full podcast walks through:

• Why prostate cancer is a cellular disease, not a targetable lump
  
• What focal therapy studies actually measure, and what they avoid measuring
  
• Why PSA reduction does not equal cancer control
  
• The real risks men underestimate
  
• How immune function determines whether cancer stays dormant or spreads

This is not about fear.
It is about clarity.

Before you decide to burn, freeze, or ablate part of your prostate, listen to the full discussion.

Watch the full podcast: Focal Treatments TULSA & HIFU: Breakthrough Or False Promise? with Dr. Stephen Petteruti to understand what focal therapy can—and cannot—do for prostate cancer.