HIFU, or High Intensity Focused Ultrasound, is a minimally invasive technique for treatment of localized prostate cancer. HIFU focuses ultrasound energy and sound waves to a targeted area in the prostate resulting in rapid temperature increases and focal ablation of the treatment zone with great accuracy. In most cases, HIFU is performed on an outpatient basis in one to four hours depending on the size of the prostate. The biggest advantage of HIFU is a very low incontinence rate of less than 2% and a post-treatment erectile dysfunction rate of 20 to 30%. The key to success with HIFU, however, is proper patient selection. Candidates include men with low- to intermediate-risk localized prostate cancer (i.e., no spread of cancer outside of the prostate). These men would have clinical stage T1 or T2b disease (i.e., no palpable nodule or nodule confined one lobe of the prostate), Gleason score of 7 or less (preferably not greater than Gleason Score 3+4=7), PSA level of less than 20, and a prostate volume of 40 grams or less. Initial data for treatment of appropriately selected men with HIFU has shown results comparable to other modalities with regard to localized cancer control, biochemical recurrence, and disease-free survival. Additionally, reported incontinence and erectile dysfunction rates after HIFU are quite low at less that 2% and 20 to 30%, respectively.
Advantages of HIFU as a means of treating select men with prostate cancer include a non-surgical, minimally invasive technique requiring no hospital stay. Additionally, the prostate cancer tissue is destroyed without any radiation exposure. HIFU is repeatable should re-treatment become necessary in the future. Additionally, HIFU can be used to treat recurrent prostate cancer that was initially treated by other means, such as radiation or proton therapy. Another impressive application of HIFU for treatment of localized prostate cancer lies in emerging successes with focal therapy of prostate cancer. In these select cases, studies would be performed to ensure a low-volume of prostate cancer limited to one lobe or a specific focal site within the prostate. The involved lobe or the specific site of the patient's prostate cancer would then be focally treated. Candidates for focal HIFU include men with low-volume (less than or equal to 3 cores positive for cancer, no single core with greater than 50% positive), Gleason Score of 6 or less, and a PSA of less than 10. These men would undergo "template" or "saturation" biopsies with greater to 24 cores evaluated. Recent studies looking at focal therapy of prostate cancer in very select men with low-volume disease are emerging and early results look promising although no long term data is yet available. Early results in some studies show up to 90% recurrence free survival following focal therapy in closely monitored men. Incontinence rates following focal HIFU were 0 to 1% and erectile dysfunction rates less than 5% in one study looking at results at three and six months following treatment.
HIFU is a minimally invasive treatment option for men with low- to intermediate-risk prostate cancer. The key to its success as with all options for treatment lies in appropriate candidate selection. HIFU is performed internationally and is currently undergoing clinical trials for FDA approval in the US. American urologists are trained in performing HIFU and work with American teams internationally in order to offer this treatment to appropriately selected patients interested in HIFU as a means of treating their prostate cancer. As always, be sure to discuss all options with your urologist including the risks, benefits and alternatives to each before making an informed decision regarding treatment of your prostate cancer. Maintain open and honest discussions with your doctor when considering these options as the key to your success is finding the treatment that suits you and your particular cancer the best.
Dr. Ali Kasraeian is one of a few surgeons in the region able to perform both laparoscopic and robotic prostate, bladder, kidney, adrenal and reconstructive surgery. In addition, he is one of North Florida's only minimally invasive surgeons trained as a HIFU surgeon.
