Prostate Cancer and High Intensity Focused Ultrasound (HIFU)

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PROSTATE CANCER AND HIGH INTENSITY FOCUSED ULTRASOUND (HIFU)

The two most commonly used treatments for early-stage prostate cancer, surgery and radiation therapy, are both associated with a significant risk of potential complications, including impotence and varying degrees of urinary incontinence.  Because of these serious side effects of prostate cancer therapy, new approaches to the management of this common type of cancer are constantly being evaluated.

High intensity focused ultrasound (HIFU) is a relatively new and non-invasive approach to cancer therapy.  Unlike more invasive cancer treatments, HIFU focuses very powerful ultrasound (sound wave) beams directly at a tumor.  These focused ultrasound beams then cause the tumor to become heated to the point that the tumor is killed.  Unlike radiation therapy, however, which is used to essentially destroy the entire prostate gland (or surgery, which requires the removal of the entire prostate gland), HIFU can be focused onto just the portion of the prostate gland where early-stage tumors are located.

A newly published research study, which appears in the current issue of the Journal of Urology, has evaluated the use of HIFU in carefully selected patients with very early prostate cancer.  In this small prospective clinical research study, 20 men with small, localized prostate cancer tumors were treated with HIFU.  Repeat biopsies of the prostate gland were then performed 6 months later, and these 20 men were then reassessed, once again, 12 months after undergoing HIFU treatment of their early prostate cancers.  (Low-risk cancers were present in 25 percent of these men, and intermediate-risk prostate cancers were present in the remaining 75 percent of these male volunteers.)

At 12 months following HIFU therapy, an amazing 95 percent of these men were still sexually potent.  Moreover, 90 percent of the men had complete control of their urinary stream (urinary continence), and 95 percent of these men did not require a protective pad in their underwear to prevent soiling of their clothes with urine.  Moreover, 89 percent of these men were simultaneously free of urinary leaks, impotence, and detectable recurrences of their prostate gland tumors at 12 months. (These extremely impressive results with HIFU reveal a complication rate that is far below what has been described for surgical removal of the prostate, and for radiation therapy for prostate cancer; as well as an excellent cancer control rate at 12 months.)

Now, a few caveats before anyone gets too excited about the results of this study.  First of all, this was a very small study, and the patients who participated in this study were very carefully selected based upon the very small size of their prostate cancer tumors.  Secondly, prostate cancer is, in general, a slow-growing cancer, and the 12-month period of follow-up of these study volunteers is much too brief to measure the long-term effectiveness of HIFU for the treatment of prostate cancer.  Finally, although HIFU is considered a non-invasive form of treatment, it generates very high temperatures within the tissues that are targeted by the ultrasound beams.  As with radiation therapy, HIFU can, therefore, also cause unintended damage to surrounding organs, and can cause some of the very same complications associated with radiation therapy.

While not yet ready for “prime time,” HIFU may still have an important future role in the management of localized prostate cancer.  However, in my view, larger clinical studies, and longer patient follow-up, will be necessary before HIFU proves itself to be equal to surgery and radiation therapy in the management of prostate cancer.

 

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Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity



Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author



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