H I F U
(HIGH INTENSITY FOCUSED ULTRASOUND)
HIFU PROSTATE CANCER
HIGH INTENSITY FOCUSED ULTRASOUND
NO BLADE NO INCISION NO SCAR NO RADIATION
QUALITY OF LIFE PRESERVATION
LOW RISK OF DEBILITATING SIDE EFFECTS
LESS TIME AWAY FROM WORK AND LEISURE
SOUND TOO GOOD TO BE TRUE?
WHAT IS HIFU?
High Intensity Focused Ultrasound
Over the past 20 years, thousands of men suffering from Prostate Cancer have benefited from HIFU or Robotic HIFU in greater than 300 centers worldwide. HIFU has been cleared for use in the USA for the ablative treatment of prostate cancer since 2015. Traditional treatment for Prostate Cancer in the United States includes the following:
Robotic Assisted Radical Prostatectomy
Open Radical Prostatectomy
External Beam Radiotherapy
My personal belief, as a physician, surgeon and cancer survivor is that prostate cancer treatment in the United States is very good. Most likely the best the world has to offer is in the United States. I do not believe in a “one size fits all” approach to prostate cancer. For example, a young, otherwise healthy male with moderately aggressive prostate cancer might be better served having a robotic radical prostatectomy than radiation therapy or active surveillance. Why? A young healthy male has many good healthy years ahead of him, which also translates into many years of potential recurrence after external radiation therapy or many years to progress and become incurable with active surveillance. Furthermore, if a patient fails radiation therapy, surgical intervention has a very high complication rate, nor can one simply have more radiation therapy because of side effects and sequelae. On the other hand, an elderly patient with multiple concomitant medical problems might be best served with active surveillance. The risk to benefit ratio of having surgical intervention for a patient in that situation is too high. My personal opinion is each patient/person is an individual. Each patient’s presentation and wishes, desires and goals are unique and there is not a one size fits all solution to prostate cancer. Lastly, I am not a big fan of active surveillance. Why? there was a big push for this in the early 1990’s and again recently. Without going into a great amount of detail I can tell you in my experience I saw many patients go from being curable to incurable. Further, many patients in the hospital with sequelae of locally advanced prostate cancer.
Why does this happen? The biggest problem I see with active surveillance despite what some of the studies show: “It’s slow growing” or “You’ll die from something else,” which all sounds good on paper…..unless, of course, you happen to be the patient. The biggest problem I see with active surveillance is that when we compare the biopsy specimen with a prostate after surgery in the pathology department. Why? It’s rare that the biopsy result and the final pathology result are the same. There is usually a greater volume of cancer and many times a more aggressive cancer than what we saw on the initial biopsy. That being said, if you are the patient, or the physician for that matter, you have to trust that what your biopsy revealed is actually all the cancer that is truly present to trust active surveillance. I can tell you with all my years of experience and multiple prostate cancer surgeries I have performed, I am not a big believer in surveillance because of that simple fact. Our imaging and cancer mapping technology has improved over the years, however; if biopsy and pathological specimens correlate in the future requires further study.
All that being said, patients, at times, have a reluctance to having prostate cancer treatment. The reason is there are risks and benefits to any treatment. With prostate cancer surgery, patient’s worry is mainly incontinence and impotence. “My prostate cancer is gone but I am wearing diapers and cannot get an erection.” Those are very real concerns for patients. “I had radiation therapy but what if it recurs?’ That is a real concern as well. Let me tell you a couple things about being a cancer survivor. I hear patients say this very often…”well if I get ten years I’ll be happy with that!!!” I can just tell you two things from my experience as a cancer survivor: First, ten years goes by in a blink of an eye. Second, surviving ten years might sound reasonable ….until about year nine. Year nine comes around very fast. All that being said, the majority of patients do not have major long term Complications with surgery or radiation therapy. Most of those problems resolve over time. Nonetheless patients do have real concerns about potential complications and are always looking for an alternative approach to treatment.
So will HIFU change the prostate cancer treatment paradigm?
HIFU has only recently been approved in the United States, however; has been in practice worldwide for the last twenty years. The studies show good cancer control, comparable to traditional prostate cancer treatments. The results of cancer control with HIFU have significantly improved over the years as the technology has improved. I believe we will need to study HIFU more extensively in the future before we have all of the answers, however; the initial studies are favorable. What makes HIFU very attractive to patients is that it offers good cancer control with very minimal side effects when compared to more traditional prostate cancer treatments. There are no incisions, no scars, no early or late side effects of radiation therapy. HIFU is performed in outpatient surgical facilities currently (whether surgery center or hospital) there is little to no pain post operatively, very minimal chance of urinary incontinence, much better outcomes with preservation of erectile function post operatively, and you are back to work and normal activities very soon after your procedure. It is possible with MRI Fusion biopsy to isolate cancer lesions and treat half of the prostate or even just the lesion itself which have even less side effects than traditional full gland HIFU. It is a treatment that can be repeated safely if a patient does have a recurrence of his prostate cancer. In very general terms, HIFU offers an alternative to traditional prostate cancer treatment. Studies initially have shown good cancer control, very minimal side effects, can be done as an outpatient. If you have a recurrence years down the road the treatment can be repeated, hence the attraction to HIFU.
STEP BY STEP HIFU PROCEDURE SUMMARY
- Patient has bowel prep night prior or morning of the procedure before arriving at our surgical center
- Patient typically will receive a general anesthesia and positioned comfortably on his side
- Ultrasound of the prostate with 3-D reconstruction is performed
- The urologist tailors the procedure millimeter by millimeter to the individual patient to achieve the best cancer control with the least possible side effects
- Ablation of the targeted tissue is performed with continuous monitoring of response to therapy
- Patient is discharged home after the procedure. (Will not be able to drive himself home because of the general anesthesia
- Because of temporary swelling of the prostate, patients generally will be discharged with a temporary urinary catheter
- Patient’s are typically monitored with PSA testing at frequent intervals thereafter.
- Patients are typically back to their normal life in a very short time with very minimal side effects.
In Summary, HIFU (high intensity focused ultrasound) can be an extremely attractive alternative to traditional prostate cancer treatment. HIFU is performed in an outpatient surgical setting. To date, studies show equivalent cancer control to more traditional
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approaches. No incision, no blade no radiation. Minimal side effects compared to more traditional approaches. Hence patients attraction to the procedure. It is important to understand all of your treatment options. I have been serving the valley for twenty years now. I have treated multiple patients with prostate cancer with all modes of therapy, and further am a cancer survivor.
Dr. Frank L. Simoncini, DO, FACOS
Southeast Valley Urology/Division of Ironwood Cancer and Research
Call me for a consultation: 480-924-7333
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