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High Intensity Focused Ultrasound Prostate Cancer

What Happens During A Hifu Procedure

High Intensity Focused Ultrasound for Prostate Cancer

How youll receive HIFU depends on what your healthcare provider is using it to treat. The best way to know what to expect is to talk to your healthcare team and ask questions.

In general, a HIFU procedure typically involves the following steps:

  • Youll lay on an exam table or sit in an exam chair.
  • The provider may use a device to stabilize the area of the targeted tissue. For example, they may use a device to keep breast tissue still or use a head frame to keep your head still for tremor treatment.
  • Depending on the situation, you may be fully conscious, lightly sedated or under general anesthesia for the procedure.
  • The provider will use ultrasound or MRI imaging to find the exact location of the targeted tissue.
  • Theyll center the head of the HIFU probe on the tissue theyre targeting. In most cases, the probe will be above or on your skin. For prostate cancer treatment, the provider will insert the probe into your rectum.
  • Theyll deliver a test dose to the center of the targeted tissue.
  • If necessary, theyll make adjustments to the power of the ultrasound beams based on the depth of the tissue.
  • Theyll deliver bursts of ultrasonic waves to the tissue.
  • Theyll use an imaging test to make sure the targeted tissue was destroyed.

Treatment with HIFU usually only requires a single session or procedure.

Hifu Allows 91% Of Patients To Avoid Radical Prostate Cancer Treatment For 2 Years

The results suggest the minimally-invasive procedure is an acceptable alternative to immediate surgery or radiation.

High-intensity focused ultrasound ablation of the prostate showed adequate short-term prostate cancer control, indicating the minimally-invasive procedure is an acceptable alternative to immediate surgery or radiation, according to new research from USC Urology, Keck Medicine of USC.1

Among 100 patients with prostate cancer who received HIFU, 91% were able to avoid radical treatment for at least 2 years, according to the retrospective analysis, which was published in the Journal of Urology. Also, nearly three-fourths of patients did not experience treatment failure, and there was a 100% continence preservation rate.

“This positive data empowers urologists to use focal HIFU ablation to effectively address prostate cancer without the intrinsic side effects of radical treatments,” first author Andre Abreu, MD, urologic surgeon with Keck Medicine and an assistant professor of clinical urology and radiology at the Keck School of Medicine of USC, stated in a press release.2″We hope this study encourages prostate cancer patients to talk to their doctor about all potential treatment options to ensure that they receive a personalized care plan that addresses their individual needs.”

References

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Is Hifu Treatment Using Focal One Safe And Effective

HIFU therapy is a newer treatment option that received market clearance in June, 2018. More than 45,000 men around the world with localized prostate cancer have received the HIFU procedure, which has demonstrated its effectiveness to reduce the need for further treatments. In Europe, where the first generation HIFU system originated and was used for whole prostate treatment, researchers published many peer-reviewed studies of the use of HIFU for whole gland ablation with positive results. Prostate Cancer treatment is considered focal when a part of the gland is spared from treatment.

Although focal HIFU treatment is available for localized prostate cancer, studies in Europe have demonstrated its safety and efficacy. In 2013, the Journal of Urology published a German study of 704 patients treated with HIFU, in which co-investigators concluded that long-term follow-up with HIFU therapy demonstrated a high overall rate of cancer specific survival and 10-year salvage treatment-free, meaning these patients did not require additional treatment for cancer after 10 years. Urologic surgeons in the US typically seek at least 10 years of data to establish focal HIFU therapy as a standard treatment.

78% Erectile Function Preservation

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Ablatherm Hifu For Pc Primary Therapy

The authors identified 11 case series assessing Ablatherm HIFU as a primary therapy option in prostate cancer , which were conducted by four study groups in Germany, France, and the Republic of Korea . Between 58 and 402 patients with localized prostate cancer with a mean age of 6672 years were treated with HIFU. In 4 of 11 case series, patients were recruited consecutively . The mean preoperative PSA level was 712 ng/mL, Gleason score was 7 in most patients, and the mean preoperative prostate volume was 2137 mL. Between 0% and 43% of men received neoadjuvant ADT, and 65100% of patients underwent TURP before or in combination with HIFU. Patients received between one and three HIFU treatments most patients, i.e. 5796%, underwent one treatment. The mean follow-up period varied between 6 and 77 months. The biochemical disease-free survival rate was 66% and 77% after 5 years , and 69% after 7 years . The negative biopsy rate was assessed in all but one study and varied between 65% and 94% the time of biopsy was not specified. In one case series the negative biopsy rate was 86% at 3 months .

What Does Hifu Involve

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Each hospital will do things slightly differently. Weve included some general information about what might happen before, during and after HIFU. Your doctor or nurse will give you more information about your treatment.

Before your treatment

If you have a large prostate, you might be offered other treatments before you have HIFU.

  • Hormone therapy is sometimes given for two to three months before HIFU. This can make the prostate smaller, and make the cancer easier to treat.
  • Transurethral resection of the prostate is an operation to remove prostate tissue and improve the flow of urine. This operation is sometimes used before HIFU to reduce the risk of some urinary problems after the treatment.

As with all treatments, these can cause side effects.

If youre having focal HIFU, you will usually go to a screening appointment first. Youll have a magnetic resonance imaging scan, which produces detailed images of the prostate and shows the location of the cancer. You may also have a prostate biopsy, which shows the location of the cancer and how likely the cancer is to grow and spread outside the prostate. These tests will help your surgeon target the area of the prostate that needs to be treated.

During your treatment

You will usually have a general anaesthetic so that youre asleep during the treatment.

Your surgeon will plan your treatment so the HIFU machine moves the beam around, heating and destroying the cancer cells in the area being treated.

Focal HIFU

Whole prostate HIFU

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Future Perspectives Of Hifu For Cancer Treatment

HIFU is a non-invasive method of destroying a target tissue without skin incision whilst sparing adjacent tissues and organs, using real-time imaging guidance and control. The HIFU treatment involves relatively little pain and can be carried out with conscious sedation and on an outpatient basis. Such a technology provides a personalized treatment, adjusted to the individual patient anatomy, pathology and treatment response. The combination of Magnetic Resonance Imaging and Focused Ultrasound , known as MRgFUS, provides an ability to plan and monitor treatment in near real time, with MRgFUS further increasing the safety profile of FUS due to real-time temperature mapping . Combined strategies have been recently addressed, in order to match the advantages of both imaging modalities . Moreover, MRgFUS allows for achieving a higher degree of accuracy in ablation of the affected tissue . In particular, MRI has the unique ability to monitor temperature and cavitation level in real time .

Opposite to thermal induction, the mechanical impact from HIFU might be considered as an alternative for eliciting apoptosis. In a recent study, researchers exploited MR-guided HIFU for inducing apoptosis, where moderate acoustic power was applied .

How Does High Intensity Focused Ultrasound Work

HIFU destroys prostate cancer through the delivery of precise and focused sound waves to a targeted spot of diseased prostate tissue. This technology uses ultrasound energy, not radiation, to destroy the targeted tissue. The Ultrasound energy, or sound waves, is transmitted through the rectal wall and focused at desired locations within the prostate identified by MRI and confirmed by ultrasound. This targeted and minimally invasive approach to treating prostate cancer leaves the healthy tissue untouched and unharmed and minimizes the chance of side effects.

According to doctors from UCLA the basic concept of how HIFU targets, burns and destroys specific prostate tissue is similar to how a magnifying glass can use the suns rays of light to burn a precise hole in a leaf at the point of intersection. Similar principles apply to HIFU. Instead of using light as the source of energy, HIFU uses sound, and instead of a magnifying glass, HIFU uses a transducer. The sound waves that are aimed at the prostate tissue, rapidly increase tissue temperature, destroying only the cancerous lesions and protecting the healthy surrounding tissue.

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Can Prostate Cancer Be Managed

Typically, there are 3 ways to manage prostate cancer. Because prostate cancer is slow-growing, it may not have a significant impact the wellbeing of most men for the remainder of their lifetime. For these conditions, active surveillance may be recommended, giving the patient and the doctor more time to assess the progression of the disease and consider options for treatment.

When more significant treatment is recommended, it may include surgery or radiotherapy, or both. These treatments tend to be a final procedure, where the treatment plan is designed to eliminate the progression and spread of cancer cells without the need for additional treatment. Recent innovations, such as with robotic surgery for prostate, reduces recovery time while retaining function, but can still produce some side-effects. Other advancements exist in radiotherapy devices, which has vastly improved treatment delivery methods and clinical outcomes.

HIFU treatment provides an additional treatment option that is designed to bridge the gap between active surveillance and the more significant treatments, such as radical prostatectomy . HIFU Focal OneĀ® treatment consists an ultrasonic probe that scans the entire prostate structure then focuses sound waves at only the cancerous portion of the prostate from within the rectum.

Are There Any Risks/complications Associated With High

High Intensity Focused Ultrasound for Prostate Cancer: Guidelines, Complications, and Outcomes

As with any medical procedure, its possible for risks or complications to arise. Speaking with your specialist or surgeon beforehand will help you to understand what these might be in your case.

High-Intensity Focused Ultrasound treatment has a relatively low risk of serious complications compared to other prostate cancer treatments. That is because it is used to treat smaller cancers in the prostate. Because it is a small treatment, it can be used again if needed in the future. Other treatments, such as removal of the prostate, or radiotherapy, can be used if prostate cancer comes back after HIFU. About 1 in 15 men might need surgery or radiotherapy by 5 years after HIFU.

Most men will notice that the amount of fluid that comes out when they ejaculate will be reduced after HIFU. They should discuss this carefully their urologist if they have plans to have children after HIFU treatment.

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Who Can Have Hifu

The National Institute for Health and Care Excellence recommends using HIFU for prostate cancer only in specific centres or as part of clinical trials. NICE is an independent organisation that provides guidance to the NHS to improve healthcare.

Your doctor might recommend HIFU if your cancer:

  • is contained inside the prostate gland. This is localised prostate cancer
  • is just breaking through the covering of the prostate. This is locally advanced prostate cancer
  • has come back after earlier treatment. This is salvage treatment

You cant have HIFU if your cancer has spread to other parts of your body. This is metastatic or advanced prostate cancer.

You might have HIFU treatment to either:

  • the whole prostate gland. This is whole prostate HIFU
  • specific areas of the prostate gland. This is focal HIFU

Efficacy Of Hifu For Pc Therapy

There is no universal consensus on the definition of biochemical failure in patients treated with HIFU . The lowest negative biopsy rate was reported for patients treated with prototype devices . Another series of negative biopsy rate of less than 80% included patients with a high risk PC . In a more recent series, negative biopsy rates have ranged from 93%96% . Stricter criteria for treatment failure were applied when failure was defined as any positive biopsy or three successive elevations in PSA with a velocity 0.75 ng/mL/year .

Retreatment rates have also been reported in the literature, but their interpretation is confounded by the former practice of using two treatment sessions with only one prostatic lobe treated in each session. This approach was common in the studies of Poissonnier et al., and Gelet et al., but the only series that did not use that approach was a study involving high-risk patients reported by Ficarra et al. .

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What Are The Benefits Of Hifu For Prostate Cancer Treatment

  • Outpatient, same-day procedure – no hospital is stay required.
  • Non-Invasive no surgery or blood loss.
  • Much shorter recovery compared to radical surgery.
  • The treatment takes a few hours as compared to weeks for most radiation treatments.
  • Most normal activities can be resumed in a few days.
  • There is minimal to no pain.
  • Limited side effectsHIFU has the lowest rate of urinary incontinence.HIFU has the lowest rate of erectile dysfunction.

Who is Eligible for HIFU Treatment for prostate cancer?

  • Individuals with early stage localized prostate cancer that has not spread or metastasized outside the prostate.
  • Those with recurrent prostate cancer after radiation therapy of any type, or if other treatment options pose a high risk of complications.
  • Individuals who want to avoid the side effects and potential complications of radical surgery or radiation.

Individual Assessments are Performed

As with any healthcare question, the answer depends on a number of individual factors.

First, the 90 percent of men diagnosed with localized prostate cancer must meet the initial criteria for undergoing HIFU and that diagnosis qualifies them for other treatments, such as radical prostatectomy, radiation therapy, cryotherapy, or active surveillance .

Beyond the raw Gleason numbers however, the tumor volume must be assessed to determine whether it is low or high. Patients with high-volume Gleason grade 6 or low-volume Gleason grade 7 are considered ideal candidates for HIFU.

Indications For Hifu Therapy Of Pc

What is HIFU?

The most widespread use of HIFU, and initially the only indication for its use, has been in patients with localized PC who are not candidates for surgery because of age, general health status, a prohibiting comorbidity or a preference not to undergo radical prostatectomy . However, with the accumulation of clinical experience and expansion of research protocols, these indications have broadened .

However, the indications have been expanded based on clinical experience to include partial and focal therapy in unilateral low volume, low-Gleason tumors, incidental prostate cancer after trans-urethral resection , salvage therapy in recurrent prostate cancer after radical prostatectomy, radiotherapy, or hormone ablation, for locally advanced prostate cancer as adjuvant local tumor-debulking therapy, non-metastatic as well as metastatic stages, and hormone-resistant prostate cancer . It is well accepted that the gland can also be downsized by 30% within 3 months of androgen deprivation therapy , besides TURP. Still remaining contraindications for the HIFU device are a missing or a small rectum and a damaged rectal wall, caused by previous prostatic/rectal therapies .

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High Intensity Focused Ultrasound For Prostate Cancer

HIFU is a treatment that uses high frequency sound waves to destroy prostate cancer cells. The waves create heat that destroys the cancer cells.

You might have HIFU for prostate cancer that hasnt spread outside the prostate or that has come back in the prostate after treatment. It is only available in specific centres in the UK or as part of a clinical trial.

What Are The Advantages And Disadvantages Of Hifu

What may be important for one person might not be so important for someone else. If youre thinking about having HIFU, speak to your doctor or nurse before deciding whether to have it. They can help you choose the right treatment for you. Take time to think about whether you want to have HIFU.

Advantages

  • HIFU doesnt involve any cuts to the skin or needles, apart from a needle in your hand to give you a general anaesthetic.
  • Focal HIFU can treat small areas of cancer while causing little damage to nearby tissue, nerves and muscles.
  • You only need a short hospital stay you can usually go home on the same day as your treatment.
  • Recovery is usually quick and most men return to their normal activities within two weeks.
  • HIFU is less likely than surgery to cause erection or urinary problems.
  • You may be able to have HIFU if your cancer has come back after radiotherapy.
  • You may be able to have HIFU again if your cancer comes back after your first HIFU treatment. This isnt the case with all treatments.
  • You may also be able to have other treatments after HIFU if your cancer comes back, such as surgery or radiotherapy.

Disadvantages

  • In the UK, HIFU is only available in specialist centres or as part of a clinical trial. You may need to travel a long way to your nearest treatment centre.
  • Compared with other treatments, we dont know how well it works in the longer term .
  • As with other treatments, you may get side effects, such as erection and urinary problems.

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What Are The Side Effects

HIFU has fewer side effects than many other treatments for prostate cancer.

After HIFU, you may have trouble getting an erection, but this usually goes away in time, and medicine can help while you regain this ability. Some men also have trouble peeing or may leak urine between trips to the bathroom.

Other side effects include pain between your testicles and your rectum, which can often be handled with medication. There’s also a risk for blood in your urine, a urinary infection, and an infection in your testicles. Always call your doctor right away if you have signs of any of these.

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