HIFU (High Intensity Focused Ultrasound) is a well established technology first approved for the ablation of prostate tissue in Europe in 1994. Since then, tens of thousands of men the world over, have been successfully treated for localized prostate cancer using HIFU. Traditional treatments for localized prostate cancer include: radical surgery (either open or robotically assisted), radiation (either by external beam or by implantation of radioactive seeds, or brachytherapy), and cryoablation (freezing the prostate). While all of these treatments can be successful, they carry significant risks of erectile dysfunction (ED) and incontinence. HIFU seeks to minimize the risk of both ED and incontinence.
What can I expect during the procedure?
During the HIFU procedure, a man is completely asleep, and lying comfortably on his right side. I use the Ablatherm device (EDAP, France) which is under robotic control and is extremely accurate with tissue ablation. An outpatient procedure, HIFU usually takes about 2-3 hours. There is one, single probe, inserted gently next to the prostate, and both imaging and treatment can be done simultaneously. This imaging advantage, using exquisite high definition ultrasound (which can also be paired with MRI images on some machines), allows me to see the nerves of erection (neurovascular bundles) which lie next to the prostate. Using the Ablatherm device, I can ablate the prostate tissue, but spare the neurovascular bundles. The result is to minimize ED post-operatively. I can also clearly visualize the sphincter mechanism, and avoid it, to optimally preserve continence.
The Benefits of HIFU
Many patients have come to me for an opinion on HIFU, noting that their own doctors were dismissive or failed to mention it as a treatment option. HIFU was approved in October 2015 by the FDA for ablation of prostate tissue. Currently, it is exclusively used for the ablation of prostate tissue in cases of prostate cancer. There are more than 100 scientific papers, in peer-reviewed journals, attesting the the safety and efficacy of HIFU for prostate cancer treatment. In the three largest studies, representing more than 2200 patients, the 10 year cancer-specific survival and the 10 year metastasis free survival was equivalent to radical prostatectomy.
Besides ablating prostate tissue with laser-like precision, HIFU can be used for partial gland, or “focal” treatment. Analogous to a breast lumpectomy, a man can retain the normal part of his prostate, while eliminating the cancerous part. The result is even less risk of side effects. Many men with a “low or intermediate grade” prostate cancer are on Active Surveillance . Their doctors are observing their prostates for any signs of progression, either in the PSA (prostate specific antigen) blood value, or on rectal exam with a finger (digital rectal exam, or DRE). Men on Active Surveillance require periodic repeat prostate biopsy. Another choice could be Focal Therapy, for men who would prefer to treat their cancer instead of worry about it growing or spreading. In a recent study from Goldberg, et al, (Current Opinion Urology, Jan 2018), patients on Active Surveillance experienced a 50% rate of progression.
HIFU can be applied to a wide range of prostate cancers. Originally, it was used for only low to intermediate grade cancers. Scientific studies have confirmed the efficacy of treating higher grade, and even locally advanced (T3) cancers with HIFU.
Larger prostates can be safely downsized with medication or with TURP (transurethral resection of prostate), prior to doing HIFU. I find that a previous TURP will greatly ease recovery after HIFU.
HIFU is a well established, safe, outpatient procedure which can cure prostate cancer in a few hours or less. Compared to other modalities, the incidence of side effects greatly reduced.