The Prostate Cancer Institute of LA are experts in diagnosing and treating prostate cancer of all stages. With expertise and access to the most advanced and precise technology, the highest level of care is provided. If you or a loved one have or at risk for having prostate cancer, contact our prostate cancer specialists at 310.341.2557.Prostate Preservation

Prostate Preservation and Focal Therapy

cancer imaging specialists beverly hillsTraditionally, two prostate treatment approaches have been available for patients with early-stage cancer: active surveillance and treatment with curative intent, including: surgery and radiation therapy, (radiation can be delivered as external beam radiation or as brachytherapy). Because cancer imaging and mapping have traditionally not been reliable, patients who undergo therapy will undergo treatment of their entire gland. In other words, if a patient has just a small focus of prostate cancer, which is limited to only a segment of the prostate, the entire gland is removed or radiated. The shortcoming of this approach is that both surgery and radiation treatment are associated with certain side effects which can include:

  • Erectile dysfunction (impotence)
  • Loss of control of urination (leaking urine)
  • Change in ejaculation
  • Bleeding
  • Damage to adjacent organs including the rectum and bladder.

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Active Surveillance

In order to maintain a patient’s quality of life, some patients with early-stage disease have been placed on a prostate preservation treatment called active surveillance. Under active surveillance, patients are not treated immediately. Instead, they are monitored closely, and with repeat biopsies, the volume and aggressiveness of their cancer is monitored. Treatment is then offered when a patient’s cancer volume increases or its aggressiveness worsens (or if the patient no longer wants to remain on active surveillance). At that time, either surgery or radiation therapy is provided to the entire gland with the potential side effects as listed above (impotence, loss of urinary control, change in ejaculation, etc.).

One of the shortcomings with an active surveillance approach to prostate preservation is that because patients are not being treated promptly and treatment is delayed until there is further progression of their cancer (either in terms of volume or aggressiveness), it’s possible that they will ultimately develop more volume of disease. If this happens, a patient’s chance of being cured is decreased, and their cancer can actually spread outside the prostate where it is no longer curable. Because of the delay in treatment, the outcomes for a number of patients on this particular prostate preservation approach will be less than optimal.

Clearly, a preservation middle ground has to be available for patients with prostate cancer. On one hand, we do not want to over-treat patients, but we do not want to delay treatment to the point that patients have lost the chance of being cured, either. The Prostate Cancer Institute of LA utilize various preservation techniques depending on each patient’s unique disease.

Learn more about Active Surveillance.

Focal Therapy

Today, that middle ground option is finally available. This option of prostate preservation is called focal therapy. For patients with early-stage disease whose cancer is limited to only a segment of the prostate, treatment options can be delivered only to the diseased areas, thereby preserving the otherwise healthy and normal tissue. With focal therapy, we are therefore able to optimize patients’ normal body functions, such as preserving their erectile function as well as their urinary control, while promptly treating their cancer and maximizing their long-term outcomes and quality of life.

minimally invasive prostate treatment LA
Focal prostate cancer therapy is now possible mainly due to the recent developments and optimization of cancer imaging modalities, biopsy techniques, prostate cancer mapping, and being able to provide targeted treatment options for patients with cancer using advanced treatment options such as HIFU. Undergoing screening and being diagnosed in the early stages of prostate cancer are key to being a candidate for focal therapy.

Given the advances in MRI prostate imaging and mapping techniques, the exact location and extent of prostate cancers can be determined. By knowing where the cancer is located, targeted therapy using modalities such as HIFU or radiation therapy can be delivered with precision. The cancer is thereby destroyed while the normal tissue and important structures (such as the nerves for erections or the muscles that assist with urinary control) can be preserved. Therefore, patients who undergo focal prostate cancer treatments can effectively treat their prostate cancer while optimizing their quality of life as focal therapy offers excellent preservation of erectile function and urinary control.

Learn more about Focal Therapy.


The Prostate Cancer Institute of LA provide state-of-the-art prostate preservation care for our patients. We have brought together a team of experts including urological surgeons with expertise in robotic surgery, MRI fusion biopsies, and high-intensity focused ultrasound (HIFU), as well as radiation oncologists with expertise in the most advanced radiation therapy modalities, radiologists who lead the field of imaging, pathologists with expertise in prostate cancer, and oncologists to provide our patients with the best treatments available today. In addition, our center provides minimally invasive and non-invasive treatment options for patients.

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By having a team of leading physicians, we have been able to create programs to help patients with all stages of cancer be treated with the most effective modalities. While we are able to provide the most advanced robotic surgery, radiation therapy, and brachytherapy options for patients who need to undergo whole gland therapies, we are particularly excited to be able to provide focal therapies for appropriate candidates using high-intensity focused ultrasound (HIFU).

The fact that many men can now treat their cancer while preserving their healthy prostatic tissue, and as a result being able to preserve their normal body function and quality of life, has created a huge groundswell of interest in HIFU focal therapy across the country. We are excited to be able to offer a new paradigm of treatment for patients with cancer and will be happy to work with you to identify which modality will be the most effective preservation approach for you.

Learn more about HIFU.

MRI TrueBeam Therapy

During a traditional TrueBeam treatment, the entire gland is treated. However, TrueBeam intensity-modulated radiation therapy (IMRT) specifically targets only the cancer within the gland, providing patients with much more focused and precise treatment.

Instead of radiating the entire prostate, which often results in an over-treatment of the gland, TrueBeam circumvents these side effects through concentrated care. The Prostate Cancer Institute of LA developed TrueBeam focal therapy options for patients with focally localized prostate cancer, which is now possible because of the advances in medical technology. Lesions identified by the perfusion dynamic MRI study are correlated during the MRI fusion prostate biopsy and prostate mapping. Through the use of the TrueBeam IMRT machine, urologists can locate, with great precision, the location of the cancer in a patient and therefore only treat the area of concern without over-treating the entire prostate gland.

Learn more about TrueBeam Therapy.

MRI Brachytherapy

Brachytherapy is a treatment option for patients that, unlike other forms of treatment, delivers radiation from within a patient, as opposed to from the outside. In years past, brachytherapy would be conducted by having have seeds placed throughout the entire prostate, which could results in over-treatment of the whole gland. However, at Prostate Cancer Institute of LA, our urologists are able to provide patients with focal brachytherapy, which directly treats cancerous tissue and not healthy tissue.

Given the progress seen in modern medical technology and ground-breaking treatment approaches, patients with focal prostate cancers are now able to receive this focused treatment. Information gathered during a perfusion dynamic MRI study is combined with the information from an MRI fusion biopsy and prostate mapping (along with real-time ultrasound imaging at the time of treatment), which allows for placement of the brachytherapy seeds to only the cancerous areas. By preserving normal prostate healthy tissue, patients can experience the benefits of effective prostate cancer treatment without its previously common side effects.

Learn more about Brachytherapy.

Contact Prostate Preservation Experts Today!

To determine if you are a candidate for focal prostate cancer therapy or alternative state-of-the-art cancer preservation options, you can reach Dr. Kia Michel and his team of experts at the Prostate Cancer Institute of LA by calling 310.341.2557. Contact us today to schedule an appointment.

Next, read about whole gland treatment.