Some prostate cancers grow slowly and don't need treatment. Others are aggressive, spread quickly, and require timely treatment with surgery, radiation, chemotherapy, or a combination. But other prostate cancers fall in the middle of this scale. They require treatment, but not as aggressive as fast-spreading tumors. And patients with this category of prostate cancer may be candidates for high-intensity focused ultrasound treatment (sometimes referred to as HIFU). It's a minimally invasive, outpatient treatment for localized prostate cancer that uses high-frequency sound waves directed at the cancerous tissue through an ultrasound probe inserted into the rectum. The sound waves direct enough energy to the tumor to cause cell death.
Clinicians use high-resolution images combined with biopsy data and real-time ultrasound imaging to provide urologists with a 3D view of cancerous tissues. Physicians can then draw precise contours around the diseased tissue and ablate only that portion of the affected organ. The procedure minimizes damage to surrounding structures, as well as the risk of urinary incontinence and erectile dysfunction.
David Crawford, MD, a urologic oncologist at University of California San Diego Health and Professor of Urology at UC San Diego School of Medicine, is one of the physicians who does the procedure at UC San Diego. The treatment option is not yet available at all cancer centers. But given its reduced risk of side effects and effectiveness compared with other treatment options, Crawford hopes the procedure becomes more widely available.
1 How does high-intensity focused ultrasound (HIFU) for prostate cancer work?
"With HIFU, you focus the sound waves and energy to heat up the cancer and kill the cancer cells. The technology has graduated from the beginning machine to the ones we use now, which use computers to very safely outline and treat the lesions in the prostate. This and other safety mechanisms built into the machine make sure we don't overheat the rectum or any of the surrounding tissue.
"The patient needs to be very still during the procedure. Usually, we do it with the patient under general anesthesia. The treatment doesn't take that long. The whole thing is usually over in a little over an hour. The side effects are pretty minimal. But it's only appropriate for the right patient."
2 Which patients are the right candidates for this procedure?
"There are some prostate tumors that are so slow-growing they don't need treatment. Some more aggressive cancers may require surgery and radiation treatment of the whole prostate. But for a subset of men, they have tumors that you don't necessarily just want to watch and wait, but you don't want to treat aggressively. They're sort of in the middle.
"The tumors need to be localized in the prostate, usually only in one or two places that are away from critical areas, like the sphincter that controls urination, the rectum, and other organs. With this procedure you can target the lesions and, with one simple outpatient treatment, can eradicate it. When it comes to treatment for prostate cancer, one size doesn't fit all. Not everyone is eligible for this technique."
3 What is the bottom line oncologists should know about this treatment?
"For men with low-risk prostate cancer that is localized (and the whole prostate does not need to be treated), HIFU may be a really good option. There are other options for localized treatment (like cryotherapy), but this is a better mouse trap in a way. It's more precise. And the technology has improved since these machines were first introduced.
"It's a step forward. But it should be used in the right person. If you don't, there's the risk of not curing the cancer or overtreating some people that may not need to be treated."
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