New minimally invasive treatment for prostate cancer at the Clinique de Genolier: focal therapy

Thanks to technological innovations, the sensitivity of MRI scans allows for fused imaging for targeted real-time guidance, both for accurate diagnosis and focused treatment. This epidemiological and technological context justifies the importance of developing effective and well-tolerated therapeutic strategies for improved post-treatment quality of life. High-intensity focused ultrasound (HIFU) is revolutionising the management of prostate cancer by offering targeted, non-invasive and personalised treatment. The concentration of ultrasonic energy destroys cancer cells with great precision while preserving surrounding healthy tissue.

Fused imaging, real-time guidance and "intelligent" algorithms make this technology safer, more effective and more comfortable for patients. It fits perfectly into the focal treatment approach, which aims to treat only the tumour area to reduce side effects. With new-generation devices and growing clinical adoption, HIFU treatment is emerging as a promising alternative for localised cancers. This innovation is redefining the standards for more precise, gentler treatment that is firmly focused on quality of life, while maintaining satisfactory local control for carefully selected tumours.

For intermediate-risk patients, recurrence-free survival of clinically significant cancer is 86% and 81% at 12 and 24 months, respectively. Five-year survival without radical and systematic treatment is 82%. Urinary incontinence is estimated at 3%, while erectile dysfunction is at 11%. Focal therapy offers satisfactory control of prostate cancer in selected patients. (2) The location of the tumour in the gland (3) and the Geason4 volume on histology (4) are the main selection criteria. Patient adherence to this treatment is 89%, and 86% would make the same choice if they had to undergo treatment again. (3)

In the event of recurrence after HIFU treatment, other therapeutic options remain available, such as active surveillance, HIFU retreatment, radical prostatectomy, radiotherapy or systemic treatment, depending on specific criteria. Follow-up treatment with HIFU is therefore possible.

Focal therapy is an effective treatment option for localised prostate cancer with limited morbidity in selected patients. This treatment is carried out in a regulated setting in accordance with recommendations. All cases are discussed and validated at focal therapy conferences.

Patients with localised prostate cancer, favourable or intermediate-risk, who wish to preserve their sexual and urinary function are ideal candidates for a focal approach.

How does it work and what is the procedure?

We use the FocalOne® robotic platform, which produces high-intensity focused ultrasound. In addition to generating ultrasound for treatment, the platform combines ultrasound imaging and probe robotisation. This probe is inserted endorectally. It is robotised and generates ultrasound for both ultrasound imaging and treatment at the same time. It is an imaging transducer and a therapeutic transducer (HIFU).

The therapeutic transducer, composed of piezoelectric crystals, generates high-intensity ultrasound focused at a single point. The HIFU transducer is curved, like a parabolic mirror, allowing the emitted ultrasound to converge at a precise focal point, the focus.

The temperature at the focus increases to around 100°C, causing coagulation necrosis and the destruction of cancer cells. The area destroyed measures 1 to 3 mm in diameter and 5 to 10 mm in length. Several successive "shots", 5 mm apart, are used to treat the target tumour volume.

The urologist defines and plans the tumour volume to be treated based on the morphology and location of the tumour. He uses 3D ultrasound images of the prostate acquired at the beginning of the procedure, which he can merge with the MRI imaging used for the targeted biopsies that led to the diagnosis. This allows the tumour to be visualised within the prostate volume. The platform incorporates safety features: a rectal wall cooling system, a motion detector that stops the procedure if the patient moves, and real-time ultrasound monitoring to ensure that the defined area is properly treated. The entire procedure is performed under general anaesthesia and lasts an average of 45 minutes. Planning and treatment.

1. All cancers by age, from 2018 to 2022 - 2018-2022 | Graph

2. Slusarczyk A, et al. Eur Urol Oncol. 2025

3. Ficarra V. et al, Prostate Cancer Prostatic Dis. 2025

4. Vickers AJ, et al. Eur Urol.2024