The benefit is in a very specific group of patients
O Conselho Federal de Medicina do Brasil autorizou duas técnicas de terapia focal — o ultrassom focalizado de alta intensidade (HIFU) e a crioablação — para casos selecionados de câncer de próstata, marcando um momento em que a medicina oncológica se afasta da destruição total do órgão em direção a intervenções mais precisas e humanas. A decisão reflete décadas de aprendizado sobre como os tumores se comportam e o reconhecimento de que preservar a qualidade de vida do paciente é tão importante quanto eliminar a doença. Para homens que vivem na zona cinzenta entre o risco baixo e o alto, essa mudança representa não apenas um novo procedimento, mas uma nova filosofia de cuidado.
- Pacientes com câncer de próstata de risco intermediário favorável agora têm acesso a tratamentos que preservam tecido saudável, reduzindo drasticamente complicações como disfunção erétil e incontinência urinária.
- A tensão central está na seleção: as novas técnicas não servem para todos — tumores de alto risco ainda exigem abordagens agressivas, e o benefício real concentra-se em um grupo muito específico de pacientes.
- O HIFU aquece o tumor a cerca de 90 graus Celsius com ondas sonoras, enquanto a crioablação o congela com agulhas de precisão — mecanismos opostos, mas com o mesmo objetivo de destruir apenas o câncer.
- Estudos indicam que as terapias focais causam efeitos adversos urinários e sexuais em cerca de 5% dos pacientes, contra taxas muito mais altas nas cirurgias radicais e na radioterapia convencional.
- O monitoramento pós-procedimento é obrigatório e rigoroso: exames de PSA, imagens e nova biópsia entre seis e doze meses garantem que o tratamento tenha funcionado.
- A cobertura pelo sistema público de saúde permanece em aberto, deixando incerta a real democratização do acesso a essas novas opções terapêuticas.
O Conselho Federal de Medicina publicou uma resolução autorizando o HIFU e a crioablação para o tratamento do câncer de próstata em pacientes cuidadosamente selecionados. As duas técnicas têm em comum o princípio de atacar apenas o tecido tumoral, poupando as estruturas saudáveis da glândula — uma abordagem que contrasta com décadas de prática oncológica baseada na remoção ou irradiação total do órgão.
A mudança não é isolada. Assim como o câncer de mama passou por uma transformação em direção a cirurgias conservadoras, o câncer de próstata entra agora em uma fase semelhante de refinamento. Stenio Zequi, do A.C. Camargo Cancer Center, descreve esse momento como a chegada da oncologia de precisão a um dos cânceres mais prevalentes entre os homens.
O HIFU destrói células cancerosas pelo calor gerado por ondas sonoras de alta intensidade, enquanto a crioablação utiliza agulhas para congelar o tumor a temperaturas extremamente baixas. Ambos os procedimentos são guiados por imagem, realizados com anestesia leve e permitem alta no mesmo dia. Os estudos apontam taxas de disfunção sexual e urinária em torno de 5% — muito abaixo das complicações associadas à prostatectomia radical ou à radioterapia.
A resolução, porém, é clara quanto aos limites: as terapias focais são indicadas apenas para tumores de risco intermediário favorável, confinados a uma região da próstata. Casos de risco alto ou muito alto continuam exigindo tratamentos mais agressivos. Zequi resume o desafio: o benefício real existe em um grupo muito específico, e identificar esses pacientes é tão importante quanto a técnica em si.
Após o procedimento, o acompanhamento é obrigatório — exames de PSA trimestrais no primeiro ano, semestrais nos dois seguintes e anuais depois disso, além de biópsia de confirmação entre seis e doze meses. Se e quando essas terapias chegarão ao SUS ainda é uma questão sem resposta.
Brazil's medical regulator has cleared two new ways to treat prostate cancer that aim to spare men from the sexual and urinary complications that have long shadowed the disease's management. The Federal Medical Council published a resolution authorizing high-intensity focused ultrasound, known as HIFU, and cryoablation—a freezing technique—for carefully selected patients whose tumors are confined to a single region of the gland. The move reflects a broader shift in oncology away from the scorched-earth approach of removing or irradiating entire organs toward strategies that target only the cancer itself.
For decades, the standard response to cancer was to take out as much tissue as possible. Surgeons removed breasts, kidneys, bladders—the logic was simple and brutal. But as imaging improved and doctors learned more about how tumors actually behave, that calculus began to change. Not every cancer needs total organ destruction. Some tumors are slow-growing and can be watched. Others are aggressive and demand intensive treatment. The middle ground—where most prostate cancers live—became the real puzzle. Stenio Zequi, who leads the urology tumor center at A.C. Camargo Cancer Center, describes prostate cancer as now entering this same phase of refinement that breast cancer entered years ago.
The two new techniques work through opposite mechanisms but share the same goal: kill the tumor and leave everything else alone. HIFU uses high-intensity sound waves to heat tissue to about 90 degrees Celsius, destroying cancer cells while preserving the healthy structures nearby. Cryoablation does the reverse, using needles positioned in the prostate to freeze tumors to extremely low temperatures, causing cell death. Both procedures are guided by imaging and include a safety margin around the lesion. Instead of removing the entire prostate or bathing the whole gland in radiation, the surgeon treats only the compromised area.
The appeal is straightforward: fewer side effects. Traditional prostate cancer treatment—whether radical surgery or radiotherapy—carries real risks. Removing the prostate can cause urinary incontinence, erectile dysfunction, and loss of ejaculation. Radiation damages sexual function too and is sometimes combined with hormone therapy that kills libido. Studies cited by Zequi show that focal therapies produce adverse urinary and sexual effects in around 5 percent of patients, compared to much higher rates with conventional treatments. The procedures are also less invasive, typically performed under light anesthesia, completed quickly, and allowing same-day discharge.
But the resolution is explicit about limits. These treatments are not a universal replacement for surgery or radiation. They are authorized only for patients with favorable intermediate-risk tumors confined to one side of the prostate. They cannot be used for unfavorable intermediate-risk, high-risk, or very-high-risk cancers. Some specific cases may qualify—patients previously treated with radiation, or those with low-risk disease who have extensive lesions or struggle with active surveillance, the strategy of monitoring tumors with regular tests instead of immediate treatment. Zequi emphasizes that patient selection is the real challenge. "Those with low-risk disease usually don't need this treatment. Those with high-risk disease need a more aggressive approach. The benefit is in a very specific group of patients," he says.
Patients who receive focal therapy will not escape monitoring. The resolution requires PSA blood tests every three months in the first year, every six months for the next two years, then annually. Imaging exams and a new biopsy between six and twelve months after the procedure will confirm whether the treatment worked. The question of whether these techniques will reach Brazil's public health system remains unanswered—the health ministry has not yet responded to inquiries about coverage.
Notable Quotes
Those with low-risk disease usually don't need this treatment. Those with high-risk disease need a more aggressive approach. The benefit is in a very specific group of patients.— Stenio Zequi, urology tumor specialist at A.C. Camargo Cancer Center
The Hearth Conversation Another angle on the story
Why does it matter that these treatments only target the tumor itself rather than the whole gland?
Because the prostate does things beyond just housing cancer. It controls urination and sexual function. When you remove it or irradiate it completely, you damage those systems in most patients. Focal therapy tries to preserve them.
So this is really about quality of life after treatment?
Exactly. A man survives cancer but can't have sex or control his bladder—that's not really survival in the way most people think about it. These techniques offer a way to fight the disease without that trade-off, at least for the right patients.
Who are the right patients?
Men with tumors that are contained to one spot and aren't too aggressive. If your cancer is slow-growing, you might not need treatment at all. If it's very aggressive, you need the full assault. The sweet spot is the middle—tumors that need treatment but aren't so dangerous that you have to destroy everything.
What happens after the procedure?
You don't just walk away. You get blood tests every few months, imaging, even another biopsy to make sure it worked. The monitoring is strict because these are still relatively new approaches and doctors need to know they're actually controlling the cancer.
Is this available in Brazil's public health system yet?
That's still unclear. The medical council approved it, but whether the government will pay for it is a separate question. For now, it's likely only available privately.
Does this change how doctors think about prostate cancer overall?
It reflects a change that's already happening. Medicine is moving away from "remove everything" toward "remove only what's necessary." Prostate cancer is just catching up to what's already happened with breast cancer and other tumors.