Second opinion before focal therapy for prostate cancer in Montreal: why it's essential and where to go

You will now be presented with treatment options—surgery, radiation therapy, active surveillance, or focal therapy such as NanoKnife . The decision you make in the coming weeks will have consequences for the rest of your life. Before committing to a course of action, there is a step that all major oncology societies recommend, but too few patients take: a second opinion from a specialist who will review your entire medical history from the beginning.

Why a second opinion for prostate cancer is not a luxury — it's a standard of care

Prostate cancer is not a single disease. It exists on a spectrum ranging from slow-growing, low-risk tumors that may never require treatment, to aggressive, high-grade cancers that demand immediate and comprehensive intervention. The same PSA value, the same Gleason score, the same stage can lead two equally qualified specialists to recommend very different treatments—and both may be clinically justified.

A second opinion is particularly important when:

• You have been diagnosed with intermediate-risk prostate cancer and are weighing focal therapy against surgery or radiotherapy

• Are you considering NanoKnife , HIFU, or another focal therapy and want to confirm that you are a good candidate?

• Your MRI is classified as PI-RADS 3 or 4 and your biopsy results are borderline

• You've been told that surgery or radiotherapy is your only option, and you want to explore whether focal approaches are possible.

• Your diagnosis was made at a center without expertise in focal therapy, and you would like the opinion of a specialist who performs these procedures.

Studies consistently show that second opinions in oncology lead to changes in diagnosis or recommended treatment in 20 to 30% of cases.

In prostate cancer specifically, the difference between a Grade Group 1 and a Grade Group 2, or between a truly localized tumour and one with extracapsular extension, can completely change the therapeutic recommendation.

What a second comprehensive opinion at the Sioufi Urology Clinic includes

At Sioufi Urology Clinic, a second opinion consultation for prostate cancer is a structured and comprehensive review of your entire diagnostic file—not a quick skim of a summary. Dr. Richard Sioufi, a board-certified urologist with over 25 years of clinical experience and specific expertise in focal therapy and prostate cancer diagnosis, personally reviews:

• Your PSA history and its velocity over time

• Your multiparametric MRI images and their PI-RADS classification

• Your biopsy pathology report, Gleason score, Grade Group and number of positive cores

• Your prostate volume, PSA density, and staging information

• Any prior processing or active monitoring data

Based on this comprehensive review, Dr. Sioufi provides a clear and frank assessment of whether the current diagnosis and proposed treatment are appropriate, whether focal NanoKnife therapy is a realistic option for the specific characteristics of your tumor, and whether further investigations — such as a PSMA PET scan or additional imaging — are warranted before any treatment decision.

Who is a suitable candidate for focal therapy?

NanoKnife focal therapy using irreversible electroporation is not indicated for all prostate cancers. It is specifically indicated for men with:

• Localized prostate cancer — confirmed as being contained within the prostate gland

• An intermediate-risk disease — Grade Group 2 or 3, PSA less than 20 ng/mL

• A unilateral tumour area or one clearly defined on multiparameter MRI

• Tumour characteristics suitable for targeted ablation while sparing surrounding structures

For men with high-grade, high-volume, or potentially extraprostatic disease, focal therapy is generally not the recommended first-line approach. In these cases, Dr. Sioufi will be direct: if the cancer requires surgery or radiation therapy, this recommendation will be made clearly, without pressure to pursue a focal approach that is not in the patient's best clinical interest.

This transparency is what distinguishes a genuine second opinion from a consultation designed to sell a procedure. At Clinique Sioufi Urologie, the goal is to offer the right treatment to the right patient—not the same treatment for all patients.

The diagnostic process at the Sioufi Urology Clinic

For patients who have not yet completed their full diagnostic assessment, the Sioufi Urology Clinic offers the complete diagnostic pathway for prostate cancer under one roof:

• PSA testing and longitudinal interpretation of PSA

• Coordination and review of multiparametric prostate MRI

• Targeted biopsy guided by MRI-ultrasound fusion for precise tissue sampling

• Review of the pathology and interpretation of the Grade Group / Gleason score

• NanoKnife focal therapy for appropriately selected patients

• Coordination with robotic surgery or radiation oncology teams when focal therapy is not indicated

From the first suspicion to the confirmed diagnosis and the therapeutic decision, each step of this journey can be managed in our clinics in Montreal (Westmount) and Châteauguay — without referral, without waiting list, with direct access to Dr. Sioufi at each step.

Why not stay in the public system?

The Quebec public health system offers excellent cancer care, and for many patients, the public route is the right choice—particularly for high-grade cancers requiring immediate surgery or radiation therapy by a multidisciplinary team. However, the public system has significant limitations for patients who need to move quickly through the diagnostic and decision-making process:

• Average wait time for a first urology consultation in Quebec: 6 to 18 months

• Waiting time for an MRI in the public system: 3 to 6 months in many regions

• Limited access for focal therapy specialists outside major university centers

• There is no guarantee of continuity of care with the same specialist throughout the diagnostic process.

A second private opinion at Sioufi Urology Clinic does not replace your public healthcare team — it gives you the information you need to make a fully informed decision, on your own schedule, with a specialist who has the time and expertise to review your case in its entirety.

Request a second opinion at the Sioufi Urology Clinic

Have you been diagnosed with prostate cancer and would like a complete and independent review of your case before committing to treatment? Book an appointment with Dr. Sioufi — no referral, no waiting list, in Montreal or Châteauguay.

Montreal (Westmount) | Châteauguay | sioufiurologie.com/nous-joindre