Prostate Preventive Cancer Treatment: Focal HIFU

Yeditepe University Koşuyolu Hospital Chief Physician and Head of the Department of Urology Prof. Dr. Faruk Yencilek explained the Focal Treatment used in the treatment of Prostate Cancer.
"When a patient comes in, whether benign or malignant, we first perform a finger prostate examination and then ask for a PSA test. In the past, we used to directly biopsy patients with hardness or abnormal PSA. Now we intervene with a special test called multiparametric MRI."

What is Multiparametric MRI?

Thanks to multiparametric MRI, we have been able to see the areas of tumors in the prostate since 2012. In the past, we could not see them. Previously, when there was a suspicion in one of the examinations and PSA results, we would take the patient directly to biopsy. However, even if there was cancer with the classical prostate biopsy, it was a bit of luck to detect it. Because the biopsy could also be taken from the cancer-free area of the prostate. With the advent of multiparametric MRI, we now upload the image of the MRI to ultrasound and give the coordinates of the tumor to ultrasound. In this way, we shoot at the tumor from 12 points and take a piece from there. The biopsy taken in this way is called 'Prostate Fusion Biopsy'. Then this piece is sent to pathology to see if it is cancerous or benign.

If the tumor is malignant as a result of a Prostate Fusion Biopsy, the urologist should immediately go to the classification of the tumor. Patients should also know this classification. "Is the tumor inside the prostate, is it outside the prostate but in the adjacent area, or is it metastatic, that is, has it jumped to another organ?" The answers to these questions determine what the treatment will be.

Which Treatment is Applied in Which Case?

Prostate cancer is divided into 3 subgroups: low risk, medium risk, and high risk.
If the tumor is limited to the organ, that is, if it is not got inside the prostate (today this is the case 60 percent of the time), we call it localized prostate cancer. This corresponds to low risk.
There are different treatment methods for low-risk, localized prostate cancer:

Active Monitoring.
Radical Prostatectomy (surgical removal of the entire prostate)
Focal Treatment.
Radiation Therapy.

All of these 4 treatments are the right option. The important thing is which patient is compatible with which treatment.

In the medium-risk group, except for active surveillance, the other 3 treatment methods are applied.
In the high-risk group, radical prostatectomy or radiation therapy is applied. However, radiation is not preferred recently.
In metastatic patients, hormonal treatments are initiated.

Focal Treatment

Focal Therapy has been used for benign prostate enlargement since the second half of the 1990s. Over time, it was seen to treat prostate cancer as well. After 2002, it started to be widely used in prostate cancer. Since 2011, focal HIFU treatment has been applied.
Focal Treatment is a suitable treatment option for low and medium-risk prostate cancer. The most important advantage is that there is no need to remove the prostate completely. With this method, the diseased area seen in the MRI is burned and the prostate remains where it is. Thus, the risk of problems in the patient's sexual life and urinary function is eliminated. With these features, Focal Treatment is also called "Prostate Sparing Cancer Treatment".

What are the Criteria for Success in Surgery?

There are 3 criteria. The oncologic result should be clean, and the patient's erection and urinary retention function should be preserved. The important thing in prostate cancer is to catch the tumor at an early stage.

Should Be Careful About Nutrition

Linoleic acid in red meat increases the rate of spread of incipient prostate cancer. Therefore, be careful about red meat consumption.
Also, be careful about being overweight. The protein called leptin and insulin-like growth factor found in adipose tissue negatively affect the development of prostate cancer. Take precautions against excess weight. Lose weight with an appropriate diet and exercise program.