How We Evaluate Men Traveling to Toronto for HIFU or NanoKnife (IRE)

For many men with localized prostate cancer, the question is not only which treatment may be appropriate. It is also whether they can access that treatment without living near the clinic.

At Urology Innovations Canada, we regularly evaluate men from outside Toronto who are interested in focal therapy options such as HIFU or NanoKnife Irreversible Electroporation (IRE). Some patients live elsewhere in Ontario. Others travel from across Canada, the United States, or internationally.

The process is designed to answer one central question before treatment is considered:

Is focal therapy appropriate for this specific cancer, in this specific prostate, for this specific patient?

That answer depends on imaging, pathology, PSA history, cancer location, prostate anatomy, previous treatment history, and the patient’s personal priorities.

First Step: Records Review

For out-of-town patients, the evaluation often begins before the patient comes to Toronto.

The most useful information usually includes:

• Recent PSA results
• Prostate MRI report and MRI images
• Biopsy pathology report
• Details of previous biopsies or treatments
• Prostate volume, if available
• Current urinary and sexual function
• General medical history

A written MRI report alone is not always enough. Whenever possible, the actual MRI images should be reviewed, because focal therapy planning depends heavily on where the cancer is located, how visible the lesion is, and how close it is to sensitive structures such as the urethra, apex, neurovascular bundles, or prostate capsule.

Why MRI Review Matters for Focal Therapy

Focal therapy is not a one-size-fits-all treatment. The goal is to treat the cancerous area while preserving as much normal prostate tissue and surrounding function as possible.

That requires precise mapping.

MRI can help identify suspicious lesions, estimate their location, and guide biopsy and treatment planning. However, the MRI must be interpreted in the context of the patient’s PSA, biopsy findings, prostate size, and overall risk profile.

A lesion that appears suitable on paper may be more complex once the images are reviewed. For example, a tumour near the apex, urethra, or neurovascular bundles may require a different treatment strategy than a tumour in a more accessible location.

This is one reason we offer both HIFU and NanoKnife IRE. These technologies work differently, and tumour geography may influence which approach is more appropriate.

This gives eligible patients access to more than one focal therapy approach, with treatment selection guided by tumour location, prostate anatomy, and clinical priorities.

Biopsy Results and Pathology Review

The biopsy report is another key part of the evaluation.

Before focal therapy is considered, our clinical team needs to understand:

• The Grade Group or Gleason score
• How many biopsy samples showed cancer
• Whether cancer was found on one side or both sides of the prostate
• Whether the MRI-visible lesion matches the biopsy findings
• Whether there is any higher-risk disease that may make focal therapy inappropriate

For patients traveling from outside Toronto, this usually means collecting and reviewing previous test results, including the biopsy pathology report and, when needed, the original pathology slides or samples.

This step matters because focal therapy is generally considered for selected men with localized prostate cancer. If the biopsy results suggest more extensive or aggressive disease, whole-gland treatment, radiation, surgery, active surveillance, or another approach may be more appropriate.

Virtual Consultation

Once the initial records are available, we contact out-of-town patients to arrange a virtual consultation. This may take place by video or phone, depending on the patient’s location, needs, and available technology.

This appointment is not simply a sales discussion about a procedure. It is a clinical review of whether focal therapy is realistic and safe to consider.

During the consultation, the physician may discuss:

• Whether the cancer appears localized
• Whether the MRI and biopsy findings match
• Whether additional testing is needed
• Whether HIFU, NanoKnife IRE, or another treatment pathway may be more suitable
• Expected recovery and catheter timing
• Follow-up requirements after treatment
• How travel can be coordinated if treatment proceeds

The consultation also gives the patient a chance to ask practical questions about timing, logistics, recovery, and what needs to happen before and after coming to Toronto.

Confirmatory MRI Fusion Biopsy

Some men contact UIC after having a standard TRUS biopsy elsewhere. Others have already had an MRI and targeted biopsy. The type and quality of previous biopsy information can make a major difference.

In some cases, we may recommend a confirmatory MRI fusion guided biopsy before treatment.

This is especially important when:

• The previous biopsy was not MRI-targeted
• The MRI shows a lesion that was not sampled directly
• PSA remains concerning despite a prior negative or limited biopsy
• The lesion location needs to be mapped more precisely
• Treatment planning depends on confirming the grade and extent of disease

This can be frustrating for patients who are eager to move directly to treatment, but it is an important safeguard. Focal therapy depends on knowing where the clinically significant cancer is. If the cancer has not been accurately mapped, treatment may be less precise.

Planning the Treatment Visit

If a patient is found to be a suitable candidate and chooses to proceed, the UIC team helps coordinate the treatment visit.

Treatment-day planning may include:

• Pre-procedure instructions
• Medication review, including blood thinners when relevant
• Required lab work or pre-anesthesia assessment
• Arrival timing
• Catheter expectations
• Same-day discharge planning
• Hotel information for patients traveling to Toronto (The Chelsea Hotel and DoubleTree by Hilton Hotel Toronto Downtown may offer special rates when patients mention they are coming for medical treatment at Can-Am HIFU)
• When the patient may be able to travel home
• Follow-up PSA and imaging schedule

Both HIFU and NanoKnife (IRE) are outpatient procedures at UIC. However, patients traveling from outside Toronto still need to plan around recovery, catheter removal, local accommodation, and follow-up instructions.

Follow-Up After Treatment

After the treatment, follow-up is used to monitor the prostate and confirm that the cancer remains controlled. This may include PSA testing, MRI, and in some cases follow-up biopsy.

Because focal therapy treats only the cancerous area and leaves the rest of the prostate in place, PSA is not expected to drop to zero. Instead, follow-up focuses on the PSA pattern over time: how much it falls after treatment, where it stabilizes, and whether it begins to rise again. PSA results are reviewed alongside MRI findings, biopsy results when needed, and the patient’s overall clinical picture.

For out-of-town patients, PSA testing is usually completed locally and reviewed by the patient’s local urologist. If the patient does not have a local urologist, they can send their PSA results to UIC for review. MRI or biopsy follow-up may also be arranged as needed, depending on the patient’s treatment, risk level, and follow-up plan.

The Goal: Careful Selection Before Travel

Traveling for prostate cancer treatment is a significant decision. UIC’s evaluation process is designed to avoid unnecessary travel when focal therapy is unlikely to be appropriate, and to create a clear plan when it may be a good fit.

The best candidates are not chosen based on distance, convenience, or interest in a specific technology alone. They are selected based on cancer biology, MRI findings, biopsy confirmation, prostate anatomy, and personal treatment goals.

For men who are suitable candidates, traveling to Toronto for HIFU or NanoKnife may provide access to a focused, minimally invasive treatment approach designed to treat localized prostate cancer while preserving quality of life whenever possible.

If you are considering traveling to Toronto for HIFU or NanoKnife, the first step is to submit your information through UIC’s consultation request process so we can review your case.