Focal prostate treatment with the FocalOne robotic system – The active present and the promising future in low-risk prostate cancer
Prostate cancer is a heterogeneous disease, ranging from aggressive progression and metastatic disposition to long-term stagnation. According to European guidelines, the patient should receive treatment tailored to the stage and grade of malignancy.
In prostate cancer, there is the entity of patients with low-risk localized disease and with an expected long life expectancy. The prerequisite is that these patients have PSA<10 ng/ml, Gleason score 3+3 or 3+4 (which is the grade of malignancy), few positive biopsies in number and limited disease within the prostate. These patients are recommended for:
- Active surveillance: These patients should be monitored by their Urologist at intervals with PSA measurement, possibly with a repeat multiparametric prostate MRI if the specialist deems it necessary and perhaps a repeat biopsy in case of a rise in PSA or an increase in the size of the suspicious lesion on MRI.
- Radical treatment: In this group of patients, is radical treatment considered overtreatment? On the other hand, some patients are not suitable for the monitoring protocol, while others do not wish to undergo the possible side effects of a radical surgical treatment.
Therefore, focal therapy in these patients, and ideally if they are over 68 years of age, is a good alternative solution.
Focal therapy
Focal therapy This identifies with great sensitivity and delimits suspicious areas, while it is absolutely essential in diagnosing the disease with transperineal prostate biopsies (through the perineum), where the entire prostate and the disease are mapped.
Various forms of energy are used, such as HIFU (high-frequency ultrasound), cryotherapy, laser, etc. That is, some treat the disease precisely focally with a 5-millimeter safety zone, others hit the entire lobe and others even the entire prostate. It is applied to patients with mild and moderately aggressive prostate cancer.
At Athens Medical Center, focal therapy with the FocalOne robotic system has been applied for the last 6 years. It is the destruction of the cancerous focus in the prostate with HIFU (high-frequency ultrasound) through the rectum, which raises the temperature to 80 degrees Celsius and kills the cancer.
FocalOne treatment is considered:
- A revolution in mild prostate cancer even in younger men who want to maintain their erectile function.
- Ideal choice for the elderly, where other types of treatments such as surgery or radiation or medications are considered burdensome for their health.
- An absolute therapeutic option for patients who had chosen radiation as a treatment and now have a relapse of the disease.
- Patients who are not good candidates for long-term general anesthesia and anesthetic conditions for radical prostatectomy.
Regarding the monitoring of the result, while after radical prostatectomy the PSA value is a reliable indicator (it must be <0.2ng/ml), in focal therapy because in most cases In cases where there is a healthy remaining prostate, any rise in PSA is not a sign of disease recurrence. The combination of PSA, mpMRI and biopsies is the best monitoring for follow-up in focal therapy.
In some studies, recurrence rates after focal therapy are slightly higher than with robotic prostatectomy, while in others they are similar. An important role is played by whether a completely focal treatment or a more extensive one (thermal destruction of the entire prostate lobe or the entire prostate) has been achieved.
Regarding functional outcomes, focal therapy yields better functional outcomes in urinary continence and erectile function in most series compared to radical prostatectomy.
Therefore, the finding of disease after treatment with FocalOne does not always constitute treatment failure (this may be very minor and require only simple monitoring). In case of treatment failure, focal therapy with FocalOne can be applied a second time, if the treatment zone is not larger than 20% of the initial one. If necessary, robotic radical prostatectomy is completely feasible with good functional results, but clearly with more fibrous tissue around the prostate.
The FocalOne is not an operation but a therapeutic intervention, performed with a short one-day hospitalization, without complications and with almost intact maintenance of urinary continence and erection. In case of recurrence in the future, it can be repeated!
The Center for Minimally Invasive Urology at the Athens Medical Center is the only Center in SE Europe, where this treatment has been applied for the last 6 years, with excellent oncological results.
