Urology visit for men, what to expect

Welcome to the Urology Clinic

Prostate cancer is the most common form of cancer in men. Thanks to regular preventive care, the disease can now be diagnosed early, in the stage of limited prostate cancer (PCa). Thanks to modern, image-based examination methods such as magnetic resonance tomography (MRT) in particular, the tumor can often be localized very precisely. From this starting point, organ-preserving therapies, above all focal therapy, play an increasingly important role. The aim of focal therapy is not to remove the entire prostate, but to remove the tumor focus within the organ. As a result, the cancer is treated effectively on the one hand and serious complications such as incontinence or impotence are avoided on the other.

 

High intensity focused ultrasound (HIFU)

The currently most modern and proven method of focal therapy is the so-called HIFU (high-intensity focused ultrasound). Here, a high-frequency ultrasound is directed to the tumor cells by means of precise location technology through the use of magnetic resonance tomography images and high-resolution ultrasound technology, which are destroyed due to the high energy transfer.

For treatment, we use the high-tech “Focal One®” device, which offers the technical prerequisites for treating any part of the prostate with millimeter precision and thereby protecting the adjacent healthy tissue. A number of scientific studies have shown that such partial treatment of the prostate promises good results in the treatment of cancer and at the same time is associated with a lower risk of side effects.

 
HIFU therapy

Anyone who opts for partial treatment of prostate cancer (focal therapy), however, also runs the risk that a previously undetected prostate cancer focus can develop into a tumor focus requiring treatment over time. If this is the case, another disease ("relapse") can develop. If necessary, either a second gentle Focal One® treatment can be performed, but other options such as surgery or radiation are available as a second treatment.

Eligibility criteria for treatment

Focal therapy is particularly suitable for patients with locally limited prostate cancer (stages at most cT2, N0, M0), i.e. the prostate cancer is located within the capsule and no metastases have yet formed. Since the treatments are very gentle, they are also suitable for patients for whom an operation is out of the question for health reasons or who do not want the standard therapies (surgery, radiation, hormone therapy, active surveillance).

An important prerequisite for the treatment is the availability of an MRT examination with the exact location of the cancer focus. There should be a maximum of 2 foci and the cancer proportion determined from this should not have any highly aggressive proportions.

In addition, the treatment method is suitable as a so-called "salvage therapy" for patients who develop prostate cancer again ("relapse") after a prostate cancer treatment. It doesn't matter which therapy was chosen for the first treatment, because Focal One® can also treat relapses after external radiation therapy or brachytherapy.

In patients with damage to the rectum (for example after radiation or rectal surgery), treatment can be excluded because the treatment is carried out through the rectum. Otherwise there are usually no exclusion criteria.

 

Treatment process

The treatment lasts between half an hour to two hours - depending on the size of the prostate area that is being treated. The treatment is preferably carried out under general anesthesia. In exceptional cases, local anesthesia (spinal anesthesia) can be used.

During the treatment, the patient is lying on his side on an operating table. In the case of spinal anesthesia, he is also given a sleeping pill so that he can lie still during the treatment. The applicator with the two ultrasound probes is inserted into the rectum and is used for both imaging and treatment.

After the doctor has completed the therapy planning, the treatment takes place with the help of a robot-assisted location system. After each treatment step, the probe moves automatically so that the entire tumor tissue is gradually destroyed. This happens, among other things, through the high temperatures of 85 to 90 ° C, which arise at the focal point of the bundled (focused) ultrasonic waves. They “boil” the tissue within seconds, so that it is permanently destroyed. A number of safety devices ensure that treatment is interrupted immediately if the lesions deviate from planning by more than 1mm. This HIFU method has been used clinically since 1993 and has proven its effectiveness in numerous studies. The HIFU system that has now been developed and used is a new development based on complex, computer- and robot-supported location, treatment and security systems. The attending physician monitors the individual steps throughout the treatment.

A follow-up check can be carried out immediately after the treatment is completed while the patient is still under anesthesia. For this purpose, the patient receives an ultrasound contrast medium and then a real-time ultrasound image of the prostate is created. In this, the doctor can see exactly which parts of the prostate have been treated and compare this result with the MRT image in which the identified tumor areas were marked. If necessary, follow-up treatments can be carried out immediately, within the same session.

As a patient, you can usually leave our clinic after three to four 3-4 days. The cost of the HIFU treatment is borne by both legal as well as private Health insurances.