HIFU (high intensity focused ultrasound) is an exciting technology that is revolutionizing the treatment of prostate cancers. Ultrasounds are harmless sound waves that have been used extensively in medical imaging. In fact, many people have ultrasounds of different body parts as part of their routine medical exams.
However, if multiple sound waves (ultrasounds) are focused on a particular spot, then in concert, they will heat up the tissue that they are focused on. By adjusting the number of ultrasound waves and their intensity, an area of interest can be heated to a point where the cells can no longer survive. However, since the ultrasound waves only create that degree of heat effect at the focal point of interest, the tissues outside of the treatment zone are preserved and unharmed. This is the concept behind HIFU.
So, HIFU can be used with great precision to destroy cancers while preserving the normal, uninvolved tissue. HIFU is extremely effective and has successfully been used to treat many types of cancer worldwide. The use of HIFU has recently been approved in the United States, and more and more men are having their prostate cancer treated with HIFU.
Whole Gland Therapy
Men diagnosed with prostate cancer who pursue a treatment option typically undergo treatment of their entire prostate gland. The prostate cancer removal is typically performed surgically (open, laparoscopic or robotic prostatectomy), with external beam radiation, with internal radiation, or with cryotherapy (freezing of the prostate). While these modalities can be effective with varying success rates, all have the potential of causing erectile dysfunction and urinary dysfunction ranging from urinary frequency, urinary urgency, obstructive voiding symptoms to urinary incontinence.
HIFU (high intensity focused ultrasound) is an outpatient treatment modality that can similarly treat the entire prostate gland with curative intent. As with other, above-mentioned, modalities, HIFU can be a very effective treatment modality for treating prostate cancer. However, because of its precision, HIFU can have favorable outcomes in regards to erectile function and urinary symptoms as compared to surgery, radiation therapy or cryotherapy.
Many patients who choose to have HIFU, do so with the aim of treating their prostate cancer while trying to minimize their post-treatment side-effects. The other advantage of HIFU is that it performed as an outpatient (not requiring hospitalization). HIFU treatment for prostate cancer typically takes about 3 hours to complete.
Focal (Partial Gland) Therapy
Due to effective screening, most men with prostate cancer are being detected when the prostate cancer is still localized to the prostate and has not spread elsewhere. Many such men are diagnosed when the prostate cancer is relatively small in volume and localized to only one segment of the prostate (the prostate has not overtaken the entire prostate gland).
To date, patients diagnosed with localized prostate cancer have had the option of being placed on active surveillance or to undergo whole gland treatment.
Active Surveillance: In effect, men with small volumes of prostate cancer can delay their therapy until their prostate cancer becomes more voluminous or more aggressive, requiring intervention. While this approach can be effective for some men, there is always the risk that the initial volume or aggressiveness of the prostate cancer may have been under-estimated and that by delaying treatment, a patient’s outcomes may have been compromised. Patients who are appropriately placed on active surveillance, are monitored over time with repeat clinical exams (PSA testing and digital rectal exams), and repeat prostate needle biopsies.
On follow-up biopsies, patients typically move forward with treatment with curative intent (for example surgery or radiation therapy) when their prostate cancer has progressed or when they no longer want to be on active surveillance. Traditionally in both of these situations, patients will undergo treatment of the entire prostate gland with either full removal of their prostate surgically or with radiation applied to their entire prostate gland. As noted, either of these therapies has the potential of sexual and/or urinary side-effects.
HIFU coupled with MRI perfusion dynamic of the prostate and more recent prostate mapping techniques offers a new treatment paradigm: focal prostate cancer therapy. Focal therapy is appropriate for patients with cancer localized to less than half the volume of the prostate. In such cases, the entire gland does not need to be treated. Only the diseased areas are treated while sparing the normal prostate tissue. This approach is very much akin to current treatment options for women with breast cancer. For most women who are diagnosed with breast cancer, the entire breast does not need to be removed. Instead, only the diseased segment or “lump” is removed. This approach is referred to as a “lumpectomy”.
HIFU, in effect, allows for a prostate “lumpectomy” to be performed, thereby preserving the remaining normal prostate tissue. Preserving the normal prostate tissue, dramatically reduces the potential for sexual and urinary side-effects. Focal prostate cancer therapy, therefore, offers excellent prostate cancer treatment results while optimizing a patient’s quality of life.
HIFU allows a physician to specifically target a desired area of the prostate with great precision, thereby allowing effective focal therapy to be performed. The involved area of the prostate is determined and mapped based on MRI and biopsy results. This information is used real time, to map out the area within the prostate that needs to be treated while preserving the normal prostate tissue. HIFU is then delivered specifically to the targeted area, thereby destroying the cancerous cells, while preserving the normal cells outside of the treatment areas. HIFU is performed as an outpatient. No incisions are necessary. The procedure typically is performed over a three hour period. Patients go home a few hours after completion of the HIFU therapy.
Results after HIFU focal therapy have shown to be excellent. HIFU focal therapy for prostate cancer can effectively eradicate cancer while preserving sexual and urinary function in a male.
Frequently Asked Questions
Q: How long does it take to perform a HIFU treatment?
A: HIFU is performed as an outpatient procedure (patients do not need to be hospitalized). The procedure is performed at an outpatient facility and patients go home shortly after they have their HIFU treatment. The duration of the procedure depends on the amount of tissue that needs to be treated. On average, each treatment will take about three hours.
Q. How do I choose a prostate cancer specialist?
A. When choosing a prostate cancer specialist, it is important to choose a specialist who is not only experienced but also one that is not biased. A urologist who only offers surgery, or a urologist who only performs HIFU, or a radiation oncologist who only offers IMRT may have inherent biases as to what they offer.
By assembling leading doctors who provide all the different therapeutic options for men with prostate cancer, the Prostate Cancer Institute of LA has been created to provide patients the most advanced and comprehensive treatment options available without the inherent biases, as prostate surgery, HIFU, radiation, active surveillance and hormonal therapies are all offered, by our leading experts.
Q. What are the outcomes of HIFU vs. Surgery and Radiation Therapy?
Q: Do I need to have a catheter after the HIFU procedure?
A: Placement of a catheter depends on the amount and location of the tumor that is being treated. Some patients will not need a catheter while others will need a catheter for an average of about five days.
Q: Will I have much pain after a high intensity focused ultrasound procedure?
A: The majority of men do not complain of pain after a HIFU procedure.
Q: When can I return to my normal activities?
A: Men will typically not have restrictions after a HIFU procedure. As some men will need to have a urinary catheter for a few days after their procedure, a few days of “taking it easy” (not exercising or engaging in strenuous activities) is recommended.
Q: Is every man with localized prostate cancer a candidate for this treatment?
A: No. HIFU is a good option for men whose prostate size and anatomy are suitable for HIFU therapy. Typically, the tumor location should be less than 4cm from the HIFU probe and no longer than 42mm in length. The presence of calcifications in the prostate and the health of the rectum are also key factors in determining who is and who is not a candidate.
Q: Are all HIFU machines the same?
A: The leading manufacturers of HIFU machines are Sonablate and Ablatherm. After extensive research, we strongly recommend the Sonablate technology for its improved versatility, depth of penetration, safety, and outcomes.
HIFU has traditionally been used to treat the entire prostate gland. The advantage of HIFU over other prostate cancer treatments (surgery and radiation) is that it is performed as an outpatient, it has almost no down time, and the preservation of erectile function and urinary control are superior to treatments with surgery or radiation therapy.
With improved imaging (multi-parametric MRI of the prostate) and mapping techniques, we are now able to accurately identify the exact location of prostate cancers in many men. Knowing where the tumor is located and having HIFU, which can deliver the ultrasound waves with pinpoint accuracy, allows us to treat cancer and areas of interest while preserving the surrounding normal prostatic tissue and vital structures. This accuracy allows us to effectively treat men with prostate cancer while preserving their quality of life (including preservation of the erectile function and urinary control). This novel approach is an exciting treatment option for many men.
To determine if you are a candidate for HIFU, you can call our HIFU specialists at 310.341.2557.
Contact Ultrasound Prostate Cancer Treatment Experts in LA
To best determine if high intensity focused ultrasound therapy (also known as magnetic resonance guided focused ultrasound) is the right choice for you, please contact the Prostate Cancer Institute of LA today. Through various tests and screening methods, our team can advise you on the best course of cancer treatment and HIFU cost.
Next, read about Prostate Preservation.