For most patients with a localised prostate carcinoma, the entire prostate must be treated through either complete removal of the prostate (prostatectomy) or radiotherapy. This is necessary because numerous tumour lesions are distributed throughout the entire prostate in over 80% of cases. This is called a multifocal tumour.
New and improved diagnostic techniques have made it possible to identify rare focal tumours at an early stage and treat them specifically. This means that we are now able to identify tumours confined to a single lesion (unifocal) or a single area, such as a lateral lobe. Tumours identified at a very early stage can also be treated with what is known as focal treatment.
However, focal therapy is only suitable for certain patients. The general state of the patient’s health plays an important role and numerous criteria must be carefully considered. The prostate tumour must be limited to just one or very few lesions within the prostate and the Gleason score (which evaluates the scale and degree of tissue change) must not be higher than 3+3 or 3+4. The PSA level is another criterion, as focal treatment is only an option for patients with a PSA level below 15 ng/ml. It is also an option if you do not wish to undergo surgery or if other health reasons make you an unsuitable candidate for surgery.
Focal treatment does not involve removing the entire prostate. Instead, the treatment focuses on a tumour lesion or the affected lateral lobe of the prostate.
Focal treatment of the prostate is a particularly promising option when focused on a single tumour lesion with a low Gleason score. The smaller the tumour lesion and the less invasive the procedure, the lower the risk that the treatment will result in damage to nerve bundles, the sphincter or the intestinal wall. Consequently, severe and long-term side effects of focal treatment are very rare. The greatest risk lies in the fact that tumour lesions could remain undiscovered and therefore go untreated. However, regular aftercare appointments can identify any growing tumours and treat them if needed.
At present, the Martini-Klinik offers the HIFU (Focal One) method and photodynamic therapy (TOOKAD) – two focal treatments that are well established and have been thoroughly examined in terms of their efficacy. There are, however, other forms of focal therapy, such as irreversible electroporation (IRE), also known as the NanoKnife system, which is currently being trialled in studies.
Prof. Dr. Georg Salomon and Dr. Yamini Nagaraj
We would be happy to advise you during our special consultation clinic on focal treatment.
HIFU method (Focal One)
Tumours occur most commonly in the peripheral zone. In such cases, the HIFU method is most suitable.
After inserting the rectal probe, the ultrasound images are fused with the images from past MRI scans. This makes it possible to draw up three-dimensional plans of the treatment area. The treatment is computer-assisted and uses the HIFU device. The HIFU waves are focused on a single location, like sunlight shining through a burning lens, and generate temperatures of 85 to 90°C, destroying the cancer tissue with millimetre precision. An external motion sensor, automatic monitoring of the distance to the rectal wall and constant cooling of the rectal wall together ensure precise treatment. The system interrupts the procedure if clearance limits are exceeded.
Around 10% of tumours are located in the anterior/ventral zone, further away from the rectum, and can therefore be reached more effectively with the TOOKAD method.
Vascular-targeted photodynamic therapy (TOOKAD) uses light to destroy prostate cancer cells. First, a photosensitive substance called TOOKAD – which can be activated by light energy – is administered intravenously. An MRI scan precisely identifies the tumour’s location so that a thin optical fibre can be inserted into these areas via the perineum. The light activates the TOOKAD substance, which gives rise to oxygen and nitrogen compounds that in turn close the vessels around the tumour. As a result, the tumour is no longer supplied with oxygen and nutrients, and the cancer cells die off. Accessing the tumour via the perineum makes it possible to reach tumours that would be impossible to access via the rectum.
The treatment is performed on an inpatient basis under anaesthetic. After the procedure, a catheter is inserted for four to eight days. Patients stay in the clinic for two days. You will be able to stand up again in the evening after the treatment.
The smaller the tumour lesion and the less invasive the procedure, the lower the risk that the treatment will result in damage to nerve bundles, the sphincter or the intestinal wall. No common, severe or long-term side effects are currently known for focal treatment. The greatest risk lies in failing to identify and treat all the cancer lesions. However, regular aftercare appointments can identify these growing tumours and treat them if needed.
For most patients with a localised prostate carcinoma, the entire prostate must be treated through either complete removal of the prostate (prostatectomy) or radiotherapy. This is called a multifocal tumour. Focal treatment does not involve removing the entire prostate. Instead, the treatment focuses on a tumour lesion or the affected lateral lobe of the prostate. Focal treatment of the prostate is a particularly promising option when focused on a single tumour lesion with a low Gleason score.
