CUHK pioneers to introduce multimodality focal therapy for prostate cancer in Hong Kong slashing surgical and hospitalisation time and reducing trauma and complications
The Chinese University of Hong Kong (CUHK)’s Faculty of Medicine (CU Medicine) has proved that a multimodality focal therapy, tailored to each patient’s tumour profiles, is effective in controlling low-to intermediate risk prostate cancer. It not only shortens operation and hospitalisation time but also minimises complications and trauma compared to conventional treatments. This marks the first systematic introduction and clinical evaluation of multimodality focal therapy in Hong Kong, offering more personalised treatment that addresses different conditions of low- to intermediate-risk prostate cancer patients. Researchers recommend promoting this novel approach to provide prostate cancer patients with more treatment options for optimal outcomes, thereby advancing precision medicine in local cancer care. The findings have been published in Prostate International, the official journal of the Asia Pacific Prostate Society (APPS).
Featured are (from left) Professor Anthony Ng Chi-fai, Tzu Leung Ho Professor of Urology, Head of Division of Urology, Department of Surgery at CU Medicine; Mr. Leung, a prostate cancer patient who received the focal therapy; Dr Samuel Yee Chi-hang, Clinical Associate Professor (honorary) from Division of Urology in the Department of Surgery at CU Medicine; and Dr Peter Chiu Ka-fung, Associate Professor from the Division of Urology in the Department of Surgery at CU Medicine.
Conventional therapies tend to cause organ dysfunctions and complications
Prostate cancer is the third most common cancer, and the fourth leading cancer killer affecting men in Hong Kong. While radical prostatectomy and radiotherapy are effective primary conventional treatments, they often carry risks of complications such as urinary incontinence and erectile dysfunction – which tend to be more severe in those over the age of 70. For patients with localised, low-to intermediate-risk primary prostate cancer, where malignancy is often confined to a specific region within the prostate, these conventional approaches may lead to risks of complications that are more distressing than the disease itself, adding strain on one’s life and finances.
The research team was the first to introduce three focal therapy modalities including high-intensity focused ultrasound (HIFU)[1], cryotherapy[2] and targeted microwave ablation (TMA)[3] since 2019. In five years, the team successfully completed focal therapy on 102 localised, low-to intermediate-risk prostate cancer patients[4] with an average age of 70. More than 40% of the patients were treated with HIFU, nearly 40% with TMA, and around 20% with cryotherapy, subject to tumour location and the level of risks. Researchers conducted regular post-operative monitoring of patients’ prostate specific antigen (PSA) levels, and performed MRI imaging and prostate biopsies within one year to evaluate the treatment’s effectiveness in terms of functional outcomes and tumour control.
CU Medicine has pioneered the introduction of multimodality focal therapy in Hong Kong including high-intensity focused ultrasound (HIFU), cryotherapy and targeted microwave ablation (TMA) since 2019. With over a hundred successful cases to date, the team hopes to offer the right choice of focal therapy modality for the right prostate cancer patients in Hong Kong.
Significantly shorter operation and hospitalisation time with minimal risk
As the study shows, compared with conventional radical surgery, multimodality focal therapy can accurately destroy cancer cells based on the tumour location. The operation time was also significantly cut by about half compared with radical surgery.
Focal therapy modalities | Tumour location in the prostate | Operation time (mins, median) | Operation time saved compared with conventional treatments such as radical prostatectomy (~180 to 240 mins) |
HIFU | Mainly posterior | 119 | ~40% |
TMA | Mainly anterior | 70 | ~ 60% |
Cryotherapy | Mainly anterior | 120.5 | ~33% |
Over 60% of prostate cancer patients were discharged on the same day following focal therapy, compared with 3 to 5 days of hospital stay after conventional radical surgery. As a whole, over 85% of patients were discharged within 24 hours post-operation.
Urological functions, including continence and erectile functions, were preserved without notable changes, and quality of life was maintained. Between six months and one year after treatment, approximately 60% of patients underwent biopsy, revealing a recurrence rate of around 20%. Most recurrent cases were classified as insignificant low risk disease (ISUP Grade Group 1)[5], requiring only routine monitoring. By the 12th month, patients treated with cryotherapy or TMA also saw significant improvement in urinary symptoms, including discomfort and obstruction.
Dr Peter Chiu Ka-fung demonstrates how focal HIFU therapy is planned. After identifying the location of the prostate tumour, precise ablation is performed using HIFU technology. Compared with conventional radical treatments, this focal therapy modality results in significantly less post-operative trauma.
Dr Samuel Yee Chi-hang illustrates how a probe is inserted into the patient’s rectum to deliver focused ultrasound energy to the specified location in the prostate, generating heat to destroy cancer cells.
The first author of the study, Dr Samuel Yee Chi-hang, Clinical Associate Professor (honorary) from Division of Urology in the Department of Surgery at CU Medicine said: “Compared with conventional surgery, focal therapy can typically be completed in one to two hours, causing fewer side effects than conventional radical treatments. This approach significantly reduces surgical trauma and psychological burden, offering a safe and effective option for low- to intermediate-risk patients who are found to be suitable for such treatment.”
Dr Peter Chiu Ka-fung, Associate Professor from the Division of Urology in the Department of Surgery at CU Medicine added: “Cancer affects each patient differently, so treatment should be personalised to suit individual conditions and needs, so as to identify the most appropriate approach. It is estimated that one in seven patients with localised prostate cancer is suitable for focal therapy, meaning whole-gland intervention is not always necessary. Even in cases of recurrence, patients have the flexibility to repeat focal therapy or seek alternatives.”
Professor Anthony Ng Chi-fai, Tzu Leung Ho Professor of Urology, Head of Division of Urology, Department of Surgery at CU Medicine, remarked: “This marks the first systematic introduction of multimodality focal therapy techniques in Hong Kong, with clinical evaluation of their effectiveness in patients with localised, low- to intermediate-risk primary prostate cancer. The study unveils a brand-new direction for focal therapy research. Among the modalities, HIFU has already been adopted as a standard treatment by the Hospital Authority. The team will further explore and consolidate the potential applications of other focal therapy approaches in patients with higher-risk prostate cancer. We aspire to advance the development of precision medicine in Hong Kong and provide more treatment options for patients.”
Professor Anthony Ng Chi-fai states that multimodality focal therapy is a novel treatment strategy aimed at providing patients with more personalised options. Among the three focal therapy modalities currently available, HIFU has already been adopted as a standard treatment by the Hospital Authority. The team hopes to collect more clinical data and offer more training in the future to advance precision medicine and benefit more patients.
Mr Leung (right) shares that after being diagnosed with prostate cancer in 2018, he followed his doctor’s advice and received focal HIFU therapy, a novel treatment. Six years post-operation, there have been no signs of cancer recurrence and only regular monitoring is required. With urological function remaining normal, the outcome has been highly satisfactory.
[1] Using thermal energy generated by ultrasound waves to destroy cancer cells.
[2] A probe is inserted into the prostate to freeze and destroy cancer cells.
[3] A probe is inserted into the prostate, delivering heat generated by microwave energy to destroy cancer cells.
[4] According to the D'Amico risk classification for prostate cancer, most patients fell into the low- to intermediate-risk categories, with approximately 30% classified as low-risk and 65% as intermediate-risk.
[5] Based on the International Society of Urological Pathology Grade Group (ISUP GG) system, prostate cancer is graded from 1 (the lowest risk) to 5 (the highest risk).
