Ultrasound surgery pushes the limits of precision. “We no longer operate with a scalpel but with a computer mouse”, underlines Dr Pascal Rischmann, professor of urology and member of the French Association of Urology, during a press conference. In a study published in the scientific journal Science Direct on December 5, the surgeon and his team compare Focal One® robotic surgical navigation treatment to classic surgery, considered the gold standard in the treatment of prostate cancer. A surgery whose effects on continence and sexuality are far from negligible.
After a diagnosis of cancer established using the triptych assay of PSA markers, MRI and biopsy, and when the indications allow, the Focal One® can be offered. Before the procedure, the MRI images are loaded into the Focal One® machine. The treatment probeintroduced into the rectum, allows you to emit 3D ultrasound images. These images are then merged to allow precise identification of the tumor. The area to be treated is defined based on all of this data and is visible on the patient’s real-time ultrasound. “It’s a personalized treatment depending on the tumor,” explains Dr. Rischmann.
The objective of this technique is toemit ultrasound directly to the prostate area to destroy cancer cells, while sparing surrounding healthy tissues. This minimizes the risk of incontinence and impotence. “It’s a minimally invasive surgery which is based on the use of ultra-targeted ultrasound emitted by an endorectal probe”, specifies the surgeon.
The ultrasound passes through the different tissues and produces, on the targeted area, intense heat between 80 and 100°C. This rise in temperature leads to the instantaneous and permanent destruction of the tissue, a phenomenon known as “coagulation necrosis”.
400 ultrasound shots to destroy a 5 mm area of tissue
The treatment consists of 400 to 600 high-intensity focused ultrasound shots. Each “shot” destroys an area of tissue measuring 5mm long by 1.7mm in diameter. The procedure is performed under regional anesthesia in a single session, lasting from 30 minutes to 2 hours depending on the volume to be treated. “No wound, no stitchesno rest in a hospital bed for days or weeks. I wore a catheter for the first 24 hours and was a little tired, but that was it. The treatment turned out to be less painful than the biopsies I had undergone”, testifies a patient in the media Santelog in 2022.
Sexuality preserved in 90% of cases
Conventional prostate cancer surgery carries a risk of impotence of approximately 50% and a risk of incontinence of approximately 10%. With this treatment, beyond the total destruction of the tumor, the risk of reduction in the quality of erections is very low. “Patients operated on by focused ultrasound retain identical sexuality in 90% of cases,” underlines Professor Pascal Rischmann.
Today, 67 centers in France practice this technique. Prostate cancer, the most common in men, affected 59,800 patients in 2018, according to Santé Publique France. “It progresses slowly until it accelerates. The only curative treatment remains surgery or radiotherapy. This technique appears to be very promising for patients,” concludes Dr. Rischmann.
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