Prostate cancer can be definitively treated with either the surgical removal of the prostate (radical prostatectomy) or with the use of different sources of energy that can teat the cancer. Some of these energy sources include radiation therapy, cryotherapy (freezing the prostate) or one of the newer treatments high intensity focused ultrasound of prostate (HIFU), which uses focused ultrasound to kill the prostate cancer cells.
In this therapy HIFU utilizes the power that ultrasound can generate to accurately kill the prostate cancer. By using a 3D ultrasound picture, energy is focused on the target, heat is generated in the focal zone and the desired tissue is destroyed. During the treatment the prostate is imaged and a mini-type of “explosion” - referred to as the popcorn effect - is visualized by the surgeon. This provides visual confirmation that the treatment has occurred. New software modifications to the device utilize changes in radiofrequency signals that are delivered pre and post treatment to confirm that the target tissue has been treated.
This technique is not yet FDA approved however a clinical trial is now underway in the US. Treatments are now available at offshore sites in Bermuda, Germany and Mexico, however, the offshore treatments are not covered by insurance carriers in the US, and the treatments are fairly costly.
HIFU is an out-patient treatment that requires a temporary urinary catheter for 7 days. Treatment times vary between 1-4 hours and can be performed under spinal anesthesia. HIFU can also be used in patients who have failed other forms of definitive therapy for prostate cancer. HIFU may also be used focally, treating a local area of prostate cancer, and leaving the healthy prostate tissue intact. Each patient’s treatment is highly individualized with adjustments being made to spare the neurovascular bundles which are responsible for erectile activity.
The ideal patient for this treatment is one who has cancer that is localized to the prostate, and is very concerned about maintaining normal erectile activity, as the incidence of impotency after these treatments is very low. Urinary incontinence is also not a common complication. The patient’s volume of the prostate should be relatively normal.
HIFU is another one of the exciting minimally invasive techniques that a Urologist can use to cure prostate cancer. The US clinical trial for this technology is ongoing and the results will not be available for several years, as post-treatment biopsies need to be obtained. Until then, despite favorable results that have been obtained in other countries, its use is limited to these overseas locations.
Published On: January 18, 2011