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Frequently Asked Question

This Frequently Asked Questions pages enables you to learn further information about prostate cancer and High Intensity Focused Ultrasound treatment (HIFU). Prostate cancer symptoms, treatments, diagnosis… You can find the answers to your questions below :

What are the most common side effects of prostate cancer treatment?

Side effects of prostate cancer treatments may vary depending on the severity of the cancer being treated and the chosen treatment. However, some side effects are more common because they are closely related to the prostate and its location. The two main side effects found with most therapies are urinary disorders/urinary incontinence and erectile dysfunction.

Urinary disorders refer to all kinds of symptoms: blood in the urine, bladder or urethra inflammation, frequent and urgent need to urinate, or even burning while urinating. Temporary or permanent urinary incontinence can also be a side effect. To limit unintended consequences of these effects, recommendations may vary from one treatment to another. For example, rehabilitation can be considered for incontinence and patients can be advised to drink plenty of non-carbonated water and avoid coffee and tea in order to have clear urine.

Erectile dysfunction refers to a loss in quality of erections. This depends on the quality of the erections before the treatment and may occur much later. Additional treatments can be offered to patients to improve this side effect.

What to do if you experience side effects?

If the patient thinks he is experiencing an unpleasant symptom, it is important that he quickly contact a doctor in order to identify the exact cause.

Focal One® is a medical device designed for the treatment of localized prostate cancer using HIFU. This device enables a minimally invasive local treatment performed in a single session, which can be repeated if necessary and is associated with few side effects. Focal One® is the latest-generation system and the first device specifically dedicated to focal therapy for prostate cancer. It allows the fusion of diagnostic imaging tools (MRI, biopsies) to precisely target only the area of the prostate affected by cancer.

The main known side effects of the HIFU treatment (total treatment of the gland) are: narrowing of the prostatic urethra (stenosis) that may occur in the months following treatment, stress urinary incontinence or erectile dysfunction.

The first results of focal treatment show excellent preservation of quality of life with minimal impact on urinary and sexual functions.

Source: Focal One patient booklet ©EDAP TMS

The HIFU treatment is said to be non-invasive because it does not require any incisions or cause any scars.

The treatment is not painful because it is done under loco-regional or general anaesthesia to avoid any movement of the patient. The post-treatment effects are not painful, but patients may feel a slight discomfort that dissipates after a few hours. As the treatment is non-invasive, there is no scarring and no burning sensation usually associated with radiotherapy.

Source : Focal One®[JO1]  patient booklet ©EDAP TMS

HIFU treatment treats localized prostate cancer by focusing high-intensity ultrasound waves on a defined area within the prostate. This concentration of ultrasound raises the temperature at the focal point, destroying prostate gland cells without damaging the surrounding tissues. HIFU treatment is mini-invasive (no incision – no radiation).

This treatment is particularly indicated for complete or radical treatment (entire gland) in patients with:

  • Localized prostate cancer at stage T1 or T2

  • A Gleason score less than or equal to 7

  • A desire to preserve optimal quality of life after treatment

Treatment of more advanced-stage cancers (T3) or more aggressive cancers (Gleason score greater than 7) may be considered; however, this option must be discussed beforehand with a urologist experienced in this technique.

HIFU treatment is repeatable and may also be used as a second-line treatment following radiotherapy failure.

Focal One and High-Intensity Focused Ultrasound

Thanks to the latest medical device in the HIFU range, known as Focal One, urologists can now choose to perform focal therapy when the characteristics of the cancer and the patient’s preferences allow it.
This therapeutic approach aims to achieve “disease control” through close patient monitoring and by repeating treatment if necessary. This innovative management strategy is currently under investigation, and early results show excellent preservation of sexual and urinary functions.

Focal therapy is emerging as an intermediate option between active surveillance and radical treatments: the cancer is effectively treated in a minimally invasive manner, preserving patients’ quality of life and reducing the psychological stress that active surveillance may represent.

Only your urologist can determine which treatment is most appropriate for you, based on the specific characteristics of your cancer.

Source: HIFU-Prostate

Based on the characteristics of your cancer and your personal preferences, your urologist will establish a treatment plan during your consultation.
In the case of localized prostate cancer, several treatment options may be offered, including active surveillance, high-intensity focused ultrasound (HIFU), brachytherapy, and cryotherapy.

Standard treatments for prostate cancer (surgery or radiotherapy) provide very good cancer control outcomes. Their underlying principle is to remove or destroy the entire prostate gland. However, these approaches carry a risk of side effects that may affect patients’ quality of life, the two most common being erectile dysfunction and urinary incontinence.

The goal of focal therapy is to treat only the area affected by cancer while leaving the rest of the prostate intact, thereby reducing the risks of erectile dysfunction and urinary incontinence.

Therapeutic ultrasound treatment, and more specifically the Focal One® system, enables precise targeting of the cancerous area of the prostate through its integrated diagnostic image fusion software (MRI and biopsies) and its new dynamic focusing treatment probe, allowing millimeter-level precision treatment.

Prostate cancers can be approached in different ways depending on their characteristics. Several modalities can be proposed, either alone or in combination.

Depending on the case, the objective(s) is (are):

  • Monitor the disease evolution to delay the initiation of a treatment;
  • Removing or reducing the tumour and/or metastases;
  • Reducing the risk of cancer returning;
  • Slowing down tumour or metastases development;
  • Treat the symptoms caused by the disease to ensure the best possible quality of life.

 

Treatment options depending on the stage of prostate cancer are:

  • Active surveillance
  • HIFU (High Intensity Focused Ultrasound)
  • Radical prostatectomy (prostate ablation)
  • Radiotherapy
  • Brachytherapy 
  • Cryotherapy
  • Hormonotherapy
  • Chemotherapy

 

The care plan should be discussed with the urologist to define the best treatment strategy based on the cancer characteristics and patient’s choices.

Magnetic resonance imaging (MRI) is similar to a scanner but using a magnetic field instead of rays. MRI of the prostate gland provides a very precise view of the soft tissue and shows whether the cancer has spread to other organs. [1] 

Prostate MRI enables the detection, localisation, estimation of the tumour’s volume and assessment of extension. This information, combined with the results of targeted biopsies, makes it possible to obtain an accurate map of the prostate cancer and to better adapt the therapeutic management of each patient. MRI also has a role in monitoring focal treatments and detecting local recurrences after curative treatment. [2]

[1] © HIFU-Prostate
[2] Prog Urol, 2015, 25, 15, 933-946

Biopsies will be essential to clear up any doubt to the clinical examination and the PSA dosage. Biopsies consist of taking several small fragments of tissue from both lobes of the prostate under ultrasound guidance and having them examined under a microscope by a pathologist.

How is a prostate biopsy performed?

These samples are taken using a special needle, through the patient’s rectum and under local anaesthesia, on an outpatient basis. The biopsies will confirm the cancer diagnosis providing prognostic information on the aggressiveness of the cells (grade of cancer expressed by the Gleason Score).

Source : “Le Cancer de la Prostate” – La Ligue contre le cancer – Septembre 2009

Gleason score is a histopronostic score of prostate cancer. It is THE prognostic factor for prostate cancer. Prostate tissue consists of several components: glandular tissue, smooth muscle tissue and stromal tissue. Prostate cancer is an adenocarcinoma resulting from tumour transformation of the prostate glands.

Gleason score grades

Gleason score defines a graded classification from 1 to 5: grade 1 is thus practically identical to the normal gland and can only be distinguished by cellular modifications, grade 3 shows the appearance of small, almost joined, glands, and grade 5 a complete destruction of the glands and the presence only of tumoural cellular clusters. When several different tumour cells are present within the gland, the Gleason score is then the sum of the grades of the two most frequent tumour cells. It can thus range from 2 (i.e. 1 + 1) graded 1-1 to 10 (i.e. 5 + 5) graded 5-5 depending on the aggressiveness of the cancer (10 representing the most aggressive cancer).

Better understand your PSA rate

Normally, PSA is below 4 nanograms per ml (ng/ml). A high level of PSA or its rapid progression of 0.75 ng/ml per year is suspicious of prostate cancer.

High PSA rate: what does it mean?

However, a high PSA level does not automatically mean prostate cancer as it can increase in various prostate disorders (prostate adenoma, prostatitis). Conversely, a normal PSA level does not mean prostate cancer should be excluded. Only a thorough diagnosis can confirm prostate cancer.

Source: “Le Cancer de la Prostate” – La Ligue contre le cancer – Septembre 2009

Increasingly effective care

Progress in the detection and treatment of prostate cancer has led to a sharp drop in prostate cancer mortality. With less than 9,000 deaths per year in France, prostate cancer is the third leading cause of cancer deaths in men, after colorectal and lung cancer. Prostate cancer, once treated, will remain under surveillance to prevent a recurrence.

Once the clinical examination has been completed, an ultrasound scan may be performed as a complement. The determination of PSA (a substance specific to the prostate that circulates in the blood) by blood test makes it possible to detect and monitor the disease evolution.

The importance of PSA rate

Depending on the stage of the disease and the treatment used, your doctor’s interpretation of the PSA level will not be based on the same criteria[1]. PSA tests are often recommended from the age of 50 onwards. The PSA level is increased in cases of prostate pathology but does not lead to the diagnosis of cancer.[2] For this, additional examinations must be carried out.[1] 

[1] Bollet MA et al. Evaluation de la réponse aux nouvelles thérapeutiques dans le cancer de la prostate métastatique résistant à la castration. JOG J Oncogeriatrie 2012; 3(1);48-55 

[2] La prise en charge du cancer de la prostate. Guide patient – Affectation de longue durée, HAS, juin 2010

Best means of detection

The first means of detection for prostate cancer is a clinical examination. Palpation of the prostate during a digital rectal examination allows for the assessment of the volume of the gland, its consistency and possible extensions to the bladder and rectum.

Prostate cancer is the second most commonly occurring cancer in men. About 1 man in 9 will be diagnosed with prostate cancer during lifetime. Prostate cancer is more likely to develop in older men and in African-American men. About 6 cases in 10 are diagnosed in men who are 65 or older, and it is rare in men under 40. The average age at diagnosis is about 66.

Prostate cancer occurence in men

Prostate cancer is the fourth most commonly occurring cancer overall. 

Prostate cancer is the second leading cause of cancer death in men. More than 79% of prostate cancer fatalities are men over 75 years old. However, Mortality has fallen steadily since 1990 thanks to improved treatment and access to screening to diagnose the disease at an early stage. 

Prostate cancer grows from prostatic glands (adenocarcinoma). Most often, it does not cause urinary disorders because it develops inside the prostate area without compressing the urethra.

However, it can happen that the cancer causes disorders, especially at an advanced stage: – Abnormal frequency of urination needs, especially at night – Difficulty in urination: weak urinary stream, incomplete evacuation… – Acute urinary retention – Pain by urinating In most cases, prostate cancer will be detected during a medical check-up. [1]

[1] Date source : « Le Cancer de la Prostate » La Ligue contre le cancer – Septembre 2009

There is no specific preventive measure for prostate cancer. Some people have a higher risk like those: [1]
– Having two close relatives (eg father, grandfather, uncle) who have been diagnosed with prostate cancer;
– Having a close relative diagnosed with prostate cancer before the age of 45;
– Of African or Caribbean origin.

Food an prostate cancer : is there a correlation ?

Food could also play a role. Several epidemiological studies conducted in the 1990s [2; 3; 4] have highlighted the bad influence of a diet containing too much fat. Animal fats would be the most harmful.

Men who do not eat fish would have two to three times more risk of prostate cancer. [5]

Finally, consumption of flaxseed could slow the prostate cancer spread by decreasing the level of testosterone in the blood (testosterone is an hormone that causes progression of prostate cancer). [6]

[1] Data source : « Le Cancer de la Prostate » La Ligue contre le cancer – Septembre 2009
[2] J Natl Cancer Inst 1993;85:1571-9
[3] Lipids 1992;27:798-803
[4] J Natl Cancer Inst 1993;85:1538-40
[5] – Lancet 2001 Jun 2 ;357(9270) :1764-6
[6] – Urology 2001 Jul ;58 (1) :47-52