Major progress in treating prostate cancer at the H.U.B 

More targeted diagnosis with the PANDORA study 

A number of tests are required to diagnose prostate cancer, starting with measuring PSA levels in the blood and a digital rectal examination. If these examinations indicate a suspected cancer, an MRI can be carried out, in some cases followed by a prostate biopsy (removal of tiny samples of prostate tissue) to confirm and refine the result. The prostate biopsy is the key examination in the prostate diagnosis as it alone can confirm the presence of a cancer and is an essential factor when deciding on the treatment options. However, this biopsy can cause discomfort to patients, present a risk of complications (infection, bleeding) and sometimes reveal indolent tumours that do not require treatment. Experts at the Brussels University Hospital are therefore exploring alternatives to the biopsy. The PANDORA study, supported by the Jules Bordet Association, the Erasmus Fund and the Belgian Association of Urology, is posing the hypothesis that by including a PSMA PET/MRI in the  diagnosis tests it will be easier to effectively select patients who genuinely need a prostate biopsy  and therefore avoid unnecessary biopsies.  “This method combines the detection of an overexpressed protein in prostate cancer cells (PSMA) by means of positron emission tomography (PET) and the carrying out of a prostate MRI,” explains Romain Diamand, the PANDORA study investigator. Although at present it is used primarily to identify a recurrence of prostate cancer, it seems that this examination is also very promising for assisting in the initial diagnosis of this type of cancer.   

More effective radiotherapy treatment thanks to an MRI-Linac  

Thanks to its expertise and multidisciplinarity, the Jules Bordet Institute is able to offer ultra- personalised prostate cancer care. Since acquiring the MRI-Linac 1.5 T, with the support of the Jules Bordet Association, the progress in radiotherapy treatment has been nothing less than remarkable. This machine, the only one of its kind in Belgium, combines the power of a linear accelerator with the image quality of an MRI to provide tumour images in real time and thus a more precise targeting of  radiotherapy. “For the patient, this kind of ultra-personalised treatment that can be adapted daily makes it possible to spare a maximum of healthy tissue, reduce the risks of toxicity compared to conventional machines and, for some prostate cancers, reduce the number of radiotherapy sessions to 5, “ explains François Xavier Otte, radiotherapist at the Jules Bordet Institute.  

Hopes for minimally invasive treatment: focal therapy 

Focal therapy is a minimally invasive treatment that can be prescribed as an alternative to surgery or radiotherapy for small tumours caught at an early stage. The principle is to treat  the cancer zone and leave the rest of the prostate intact and thereby avoid risks of impotence and incontinence. There are several types of focal therapy: ultrasound, cryotherapy and laser. The Jules Bordet Institute is the only centre in Belgium to propose focal therapy using HIFU (High Intensity Focal Ultrasounds) technology that employs high energy ultrasound to destroy the disease. Research into focal therapies is very promising and a number of trials are in progress to validate new protocols. Microwave ablation has already shown its effectiveness in treating a number of organs. “The VIOLETTE study is seeking to prove its effectiveness in treating prostate cancer thanks to ultra-focal therapy with a microwave ablation protocol with image fusion so as to achieve a very precise  elimination of the tumour core, thereby neutralising it without harming the prostate functions,” explains Alexandre Peltier, urologist and principal investigator with the VIOLETTE study.