May 2024Spotlight feature

Improved surgical procedures offer new hope in treating prostate cancer

JGH using minimally invasive techniques as potent weapons against the disease

In early 2023, JGH patients Marc Audet and Dr. Michel Drouin happened to find themselves in a similar quandry, as they tried to choose the medical treatment that seemed most promising in their life-and-death battle with prostate cancer.

A common option, they were told, is the surgical removal of the prostate (radical prostatectomy) to spare the body further contact with—and damage from—the tumour. Unfortunately, the side effects include possible prolonged urinary incontinence and frequent erectile dysfunction, the latter being especially difficult for younger men.

Close-up of the electrodes used during irreversible electroporation, a procedure in which an electrical field destroys prostate cancer cells.

Close-up of the electrodes used during irreversible electroporation, a procedure in which an electrical field destroys prostate cancer cells.

The unappealing alternative was radiation therapy—combined with hormone therapy in Dr. Drouin’s case—whose long list of side effects threatened to significantly downgrade the quality of the men’s lives physically as well as psychologically.

Then their physician, Dr. Maurice Anidjar, Chief of the Department of Urology at the JGH, threw them a lifeline: Both were suitable candidates for relatively new procedures that are not widely available at other hospitals in Canada.

Dr. Drouin, who was 79 at the time, stood to benefit from a minimally invasive technique known as irreversible electroporation (IRE). To destroy the cancer cells without generating heat, electrodes encircle the tumour and create an electrical field that tears irreparable holes in the cells.

Meanwhile, Mr. Audet, who was 59, was offered the chance to undergo another type of minimally invasive procedure, high-intensity focused ultrasound (HIFU), in which a probe in the rectum emits powerful bursts of ultrasound to generate heat that kills the cancer cells.

Both men were intrigued by the fact that their respective procedures would be minimally invasive and would only take about an hour, with no overnight hospital stay and no need for narcotic drugs or pain-killers.

Little post-surgical pain or discomfort was expected, aside from the requirement that a urinary catheter remain in place for about a week.

In the minimally invasive procedure known as high-intensity focused ultrasound (HIFU), a probe (shown in the photo) emits powerful bursts of focused ultrasound to generate heat that kills prostate cancer cells.

In the minimally invasive procedure known as high-intensity focused ultrasound (HIFU), a probe (shown in the photo) emits powerful bursts of focused ultrasound to generate heat that kills prostate cancer cells.

As a result, Mr. Audet underwent his HIFU procedure in March 2023 and Dr. Drouin had his IRE a month later. Both are in good health today, having experienced no significant side effects. In fact, Dr. Drouin remembers his catheter being merely “an annoyance and a nuisance, which is a small price to pay to hopefully be cured of cancer.”

“I’m very happy with my decision,” says Mr. Audet. “Otherwise I wouldn’t be talking about it now. I’m hoping that by being so open, other men will discover they have wider options after they’ve been diagnosed with prostate cancer.”

According to Dr. Anidjar, the location of the tumour helps to determine which procedure is used. IRE is better for anterior tumours (away from the rectum), while HIFU is used on posterior tumours (closer to the rectum).

When IRE was introduced in 2022, the JGH became the first teaching hospital in Quebec and one of the few in Canada to offer the procedure.

The JGH was also the first hospital in Quebec to begin using HIFU in 2014. Strictly speaking, the technique is not new, but the technology at the JGH was substantially upgraded in 2022 by the acquisition of new and more techically demanding equipment.

Both procedures were inaugurated with strong support from the JGH Foundation and its donors.

Dr. Anidjar, who has teamed with Dr. Rafael Sanchez-Salas (an MUHC urologist), says he waited until now to call attention to the arrival of IRE and the enhancement of HIFU, because he wanted to be certain that patients recovered well and remained healthy.

This is why Dr. Drouin and Mr. Audet are telling their stories more than a year after they underwent their treatments.

“As a physician who did a fair amount of clinical research in my day, I was able to read quite a lot about IRE before the surgery,” says Dr. Drouin, a retired specialist in allergies and immunology.

“On one hand, I found that IRE was new to the Jewish, relatively new to Canada and rare in the U.S. On the other hand, it was well established in Australia, in several European countries and even in a few Asian countries.

JGH Foundation provided crucial support for vital treatments for prostate cancer

IRE could not have been introduced and HIFU could not have been upgraded in the Department of Urology at the JGH without essential support from the JGH Foundation.

Donations can be made online to support any of the JGH’s programs and services.

“In fact, the Australian publications reported very good results and very good overall tolerability.

“There was also another important point in its favour: Dr. Anidjar explained that if IRE did not totally get rid of my cancer, there was no reason I couldn’t be re-treated with IRE or with one of the original two options. What did I have to lose? On balance, it was an attractive possibility, so I decided to give it a go.”

Mr. Audet was equally encouraged by the possibility of re-treatment with HIFU, if the initial results fell below expectations.

Dr. Anidjar also advised him that after the surgery, he would need to be closely checked on a regular basis. However, to Mr. Audet, this was a minor consideration that he now recalls with a chuckle: “As I said to Dr. Anidjar, ‘If I do that for my car, why wouldn’t I do it for myself?’”

Dr. Anidjar describes both treatments as “very demanding” for medical staff, given the degree of precision that is required and the relative novelty of the procedures. However, he says, the results are well worth the effort.

For example, not only is the HIFU technology now more accurate than ever, it delivers immediate feedback while the procedure is under way, including information about the amount of tissue that has just been burned.

Mr. Drouin says he’s delighted with the medical outcome, not to mention the ability to resume all of his previous activities. “It’s as though I never even had a procedure on my prostate,” he exclaims.

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