The Non-Invasive Outpatient Treatment For Localized Prostate Cancer
Treatment Options In January of 2006, High Intensity Focused Ultrasound (HIFU) became an approved but not insured procedure in Canada for the treatment of prostate cancer.
Most people are aware of ultrasound as a diagnostic modality that is non-invasive and painless. When different frequencies of ultrasound are used, it can cause controlled tissue damage or destruction. That principal is utilized in HIFU.
HIFU is a non-invasive outpatient procedure performed under spinal anesthetic that kills prostate cancer by “heating and ablating” the tissue. The principle is very similar to when we would hold a magnifying glass at a distance from a leaf in our childhood days. The magnifying glass would focus the sun’s rays to burn a very small hole (the focal point) in the leaf, while preserving the normal leaf surrounding the hole.
HIFU is performed after inserting a uniquely designed transrectal ultrasound probe into the patient once the spinal anesthetic has been administered. In most cases he also given some IV sedation, because it is very important for the patient to lie perfectly still during the whole procedure.
It takes about three hours to plan and treat the average prostate. The patient is then recovered, goes home/back to the hotel the same day, travels the next day and usually can return to work within 24-48 hours. With HIFU there is no cutting, no bleeding, no general anesthetic, very little pain, and no hospital stay and usually an earlier return to work.
Over the last few years there have been some changes in the approach to prostate cancer treatment. If there is a low or medium grade prostate cancer, in certain situations we are suggesting “active surveillance” approach. This means careful and regular monitoring, usually with a planned repeat biopsy if no change in the PSA or a PSA stimulated repeat biopsy.
"Historically, there was often a 30 percent chance, after doing the radical prostatectomy, of finding cancer in a different area, higher grade or on the opposite side to where the Ultrasound Guided biopsies were positive."
If the patient progresses on the repeat biopsy (higher grade or greater volume of prostate cancer) or if the patient would prefer some treatment (rather than active surveillance) that is non-invasive and provides minimal side effects the focal or extended focal HIFU treatment is ideal.
Historically, there was often a 30 percent chance, after doing the radical prostatectomy, of finding cancer in a different area, higher grade or on the opposite side to where the Ultrasound Guided biopsies were positive.
To minimize that risk, we have been suggesting a prostatic magnetic resonace imaging (MRI) scan for these patients prior to providing the focal HIFU. The MRI has been proven to be very reliable in confirming that there is no “clinically significant” areas of prostate cancer different than were detected by the biopsy. It will also determine if there is cancer that has spread beyond the capsule of the prostate.
Once confirmed by MRI that there are no more suspicious areas, we will then only treat those areas that are biopsy proven to be positive.
The benefits of Focal HIFU therapy are shorter treatment time, less risk of side effects because much less tissue is ablated, usually the patients leave with no catheter or just a foley (through the passageway) not a suprapubic catheter. If a foley is placed, usually it stays for only a few days.
Repeat or Salvage HIFU
Another benefit of HIFU is the fact that if the first treatment fails, meaning a rising PSA with biopsy proven recurrence in the same area or a different area, we have the ability to offer a second or even a third HIFU treatment. One cannot do radiation or surgery a second time, if there is a recurrence.
Salvage HIFU has been successfully been offered to another very difficult and desperate group of prostate cancer patients. In those men that have failed primary curative cancer treatment using external beam radiation or brachytherapy and have biopsy proven recurrence, we have treated with focal or total salvage HIFU. We have seen some spectacular secondary cures with low incidence of side effects in this population where the only other options could be salvage surgery or hormonal treatment.