When Should I Worry About...

HIFU: Innovative Treatment for Prostate Cancer

May 3, 2024 - Kim Rivera Huston-Weber

Prostate cancer is the most common cancer in men, according to the National Cancer Institute, diagnosed in 1 in 8 men in their lifetime. Fortunately, treatment has evolved greatly since the first surgeries and treatments in the 19th and 20th centuries.

In recent years, the FDA has approved high-intensity focused ultrasound (HIFU), a highly targeted treatment that can remove and control cancer without the side effects that can accompany other therapy. It's a newer technology used to treat early-stage cancer that hasn't spread beyond the prostate.

What is high-intensity focused ultrasound?

HIFU is a minimally invasive procedure that targets cancerous prostate tissue with heat that's created by sound waves at high frequencies.

Remember childhood cartoons where a character would use a magnifying glass to target ants using the sun's rays? HIFU works in a similar way. In HIFU, sound is the energy source, and an ultrasound probe targets the cancerous prostate tissue. The sound waves increase the tissue's temperature and only destroy the targeted tissue while keeping the surrounding healthy prostate tissue safe.

"It's a heat treatment — we know that if you apply enough heat to cancer, you will potentially kill it," says Dr. David Mobley, a urologic oncologist with Houston Methodist. "What HIFU does is repeatedly deliver tiny areas of temperature up to about 185 degrees to areas about three millimeters in size to the prostate. The average prostate will get about 600 little bursts of 185-degree temperature all throughout the area where the cancer is."

HIFU requires no radiation or incisions. The procedure is pain-free since a person is placed under general anesthesia. Once the patient is fully asleep, an ultrasound probe is positioned in the rectum. The urologist uses the ultrasound to find and deliver treatment to the cancerous area in bursts that last only a few seconds. Depending on the size of the affected area, the procedure can take around one to two hours.

"It's a generally painless, one-time, simple outpatient treatment with a very high success rate," Dr. Mobley says. "You go home the same day, with minimal post-operative discomfort. It's a faster recovery time than other procedures. Men can return to normal activity essentially the next day."

Why HIFU for prostate cancer treatment?

Treatments for prostate cancer can vary depending on individual factors, including the type and stage of prostate cancer and a person's age and current health. Surgery (radical prostatectomy), radiation and/or chemotherapy are all treatments that can be used for aggressive, large tumors that may be at advanced stages. For early-stage prostate cancer that's at low risk of growing or spreading quickly, there can be a few different approaches to the condition.

With low-grade cancer, one option is active surveillance or observation, in which you work closely with your urologist to get screenings, scans and biopsies at set times to monitor any cancer growth. The types of tests and the frequency will largely depend on someone's diagnosis and preferences, with treatment beginning when the cancer looks to be growing.

This approach is considered since slow-growing prostate cancer may never spread or will grow so slowly that the side effects of standard treatment, including erectile dysfunction and urinary incontinence, may have more impact on someone's quality of life than the cancer diagnosis would.

For someone who feels uncomfortable with active surveillance and wants treatment, surgery and radiation can both be options, but they can come with those side effects. HIFU is an alternative that can treat prostate cancer but generally leave the surrounding tissue, nerves and blood vessels unaffected.

"The risks with prostate cancer surgeries, such as bladder control and sexual dysfunction problems, is very, very low for those with HIFU," Dr. Mobley says. "So HIFU is very effective in curing cancer with a very minimal effect on the quality of life. The advantages are significant."

Who is the best candidate for HIFU?

HIFU is not a treatment for all prostate cancers — the cancer must be localized to the gland and in an early stage to qualify.

"The ideal candidate would be somebody who has prostate cancer that's not highly aggressive, with no evidence of spread," Dr. Mobley says. "You want it to be localized to the prostate and in a prostate that's not exceptionally large."

In some men, HIFU can be used as "focal" therapy, meaning only the affected area of the prostate is treated. According to Dr. Mobley, 20% to 30% of men with prostate cancer are good candidates for focal therapy.

"With regards to focal HIFU, there's really no other treatment that's this effective for highly localized prostate cancer," Dr. Mobley says. "Choosing the right patient is, of course, important. Not every man that has prostate cancer is a candidate for HIFU, but there are undoubtedly many men who are receiving more aggressive treatment that could benefit from HIFU if they just knew about it."

Work with your care team to understand a prostate cancer diagnosis

Just hearing the word "cancer" is enough to produce fear. When facing a prostate cancer diagnosis, Dr. Mobley believes patients should take an active approach to understanding their condition and treatment options so they can feel comfortable and confident moving forward with their treatment plan.

"Be sure you spend enough time with your urologist and understand all of the ramifications and the potential pluses and minuses of treatment," Dr. Mobley says. "And I would not launch into treatment until I was satisfied that I had all my answers. Be sure to have a long enough discussion with your surgeon so that you're comfortable. And it never hurts to get a second opinion."

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Categories: When Should I Worry About...