HIFU (High intensity focused ultrasound) is a exciting technology that is revolutionizing the treatment of prostate cancers. Ultrasounds are harmless sounds that have been used extensively in medical imaging. In fact, many people have ultrasounds of different body parts that are part of their routine medical exams. However, if multiple sound waves (ultrasounds) are focused on 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 the focal point of interest, the tissue outside of the treatment zone is preserved and unharmed. This is the concept behind HIFU. 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 therapy.
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 prostate imaging (multi-parametric MRI of the prostate) and prostate 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 the 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 focal therapy, you can call our prostate cancer specialists at: 310.341.2557
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, laparscopic or robotic prostatectomy), with radiation (IMRT, Brachytherapy), 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 complete urinary incontinence.
HIFU is an outpatient treatment modality that can similarly treat the entire prostate gland with curative intent. As with other, above mentioned, modalities, HIFU is very effective for treating prostate cancer. However, because of its precision, HIFU can have superior 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 advantages of HIFU are that it is performed as an outpatient (not requiring hospitalization) and it has almost no down time. HIFU treatment for prostate cancer typically takes about one to three hours to complete.
As with any treatment modality, the expertise and experience of the treating physician is of paramount importance. The HIFU specialists at Prostate Cancer Institute of LA are some of the most experienced HIFU specialists in the country.
For more information, contact one of our HIFU specialists at (310) 341-2557.
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 imaging 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 cancers involving less than half the volume of their 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 one to three hour period. Patients go home a few hours after completion of the HIFU therapy and have just about no down time.
Results after HIFU focal therapy have shown to be excellent. HIFU focal therapy for prostate cancer can effectively eradicate the cancer while preserving sexual and urinary functions in a male.
Post Radiation HIFU
Some patients who elect to undergo radiation therapy (either with external beam IMRT or with internal radiation) to treat their prostate cancer may develop local recurrence of their disease. Historically, treating prostate cancer radiation failures has been difficult, as such patients cannot receive additional radiation therapy and trying to surgically remove a prostate after it has been radiated is very challenging and fraught with significant side effects, including severe incontinence, rectal fistulas, loss of erectile function and pelvic pain. However, HIFU can be effectively utilized to treat patients who have failed prostate radiation therapy with relative ease and good outcomes. Using HIFU for radiation therapy failures still allows patients to achieve a cancer free status with an outpatient procedure. The prostate is mapped out and the HIFU is used to treat the residual cancer cells in the prostate. Either focal HIFU therapy or whole gland HIFU therapy can be utilized depending on the extent of the prostate cancer recurrence.
Post Cryo-Therapy HIFU
While Cryotherapy can be an effective means of treating patients with prostate cancer, some patients will develop local recurrence of their prostate cancer after undergoing cryotherapy. Treating such patients can be challenging. However, HIFU provides an effective means to treat such patients. Patients with post-cryotherapy prostate cancer recurrence can also be treated with surgery (salvage prostatectomy). Compared to salvage surgery however, HIFU is less invasive, is performed as an outpatient procedure and provides less side-effects. Both surgery and HIFU can be effective in treating recurrent post-cryotherapy prostate cancers.
Q: How long does a HIFU treatment take?
A: HIFU is performed as an outpatient procedure, wherein patients do not need to be hospitalized. The procedure is performed at an outpatient facility and they go home shortly after they undergo HIFU. The duration of the HIFU procedure depends on the amount of tissue that needs to be treated. On average, a HIFU treatment will take about an hour and a half to three and a half hours.
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 HIFU procedure?
A: The majority of men do not complain of pain after a HIFU procedure.
Q: When can I return to my normal activities after HIFU?
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 HIFU 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 HIFU?
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 for HIFU.
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 and safety.
Contact HIFU Therapy 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 prostate cancer treatment.
Next, read about da Vinci Robotic Prostatectomy.