High Intensity Focused Ultrasound has been used to treat prostate cancer for over a decade in Europe, and has been approved for treatment in Canada since 2003. It is not currently available in the U.S. The cure rate using HIFU is similar to the traditional treatment methods of surgery and radiation, but with fewer significant side effects and less negative effect on quality of life.
Who Can Benefit From HIFU?
HIFU therapy is recommended for patients with localized T1 and T2 stages of prostate cancer. It is frequently chosen over more traditional surgical or radiotherapy treatments due to its low complication rate and relatively small chance of significant side effects.
Where impotence and radiation burns are common side effects from traditional treatments, side effects from HIFU are less radical and there are fewer occurrences of impotency and incontinence.
High Intensity Focused Ultrasound (HIFU)
Ablatherm HIFU does not involve surgery but instead uses high intensity focused ultrasound waves to destroy cancerous prostate tissue. It is done on an out-patient basis so there is typically no hospital stay required.
A local spinal anesthetic is used in combination with sedation through intravenous. A probe is inserted into the patient’s rectum and a focused beam of ultrasound waves is projected at the cancerous tissue on the prostate. The prostate is located in front of the rectum, so the computer guided probe can deliver the ultrasound waves through the rectal wall. A specially trained urological surgeon controls the procedure.
The prostate tissue targeted is heated to temperatures in excess of 85°C destroying the cancerous cells. This process is repeated with a variable focal point until all of the cancerous material has been heated and destroyed. To treat the whole of the affected prostate area typically takes up to 3 hours.
Immediately after the treatment, swelling of the prostate is expected. A temporary urinary catheter is put into place until the swelling recedes. This usually takes up to 14 days depending on the patient.
The patient is discharged the day of the treatment with no dietary restrictions. The catheter can be removed roughly 14 days later. Antibiotics are prescribed for 2 weeks and PSA levels will be monitored for 3 months following the treatment.
Some complications that may occur are,
- Mild bleeding in the first stream when urinating
- Frequent and possibly an urgent need to urinate
- Urinary leakage upon physical exertion
Prostate cancer is a condition where cells within the prostate grow uncontrollably, often creating multiple small tumors within the gland. Early detection of the disease is critical because the cure rate is in excess of 90% when the cancer is confined to the prostate gland.
One treatment option using HIFU therapy is to spare the nerve entering the prostate when no cancerous cells have been detected in the nerve. If PSA levels after treatment remain high, the treatment can be repeated.
In a 5 year study at the University of Regensburg, Ablatherm HIFU resulted in over 93% of patients with T1 or T2, that is, prostate confined cancer, showing no return of cancer cells 22 months after treatment.
Side effects recorded during this study were minimal for the most part.
- Death 0%
- Digestive complications 0%
- Mild to moderate urinary incontinence 5%
- Total urinary incontinence < 1%
- Blockage of the urethra 8%
- Sexual impotence with nerve-sparing procedure 20%
- Sexual impotence without nerve-sparing procedure 66%
Another positive result from this study was that none of the patients reported a decline in their quality of life after completion of the treatment.
The overall findings of this study and usage of this procedure since the study show that HIFU prostate cancer treatment can provide a cure of the disease if it is caught in its early stages.
Because HIFU prostate cancer therapy is non invasive, it can be repeated or used as a follow-up to external beam radiation therapy. Patients showing a recurrence of the disease after treatment remain eligible for a repeat procedure or for surgery, radiotherapy or hormone therapy where required. HIFU therapy has proven itself to be an effective first treatment for early stage prostate cancer patients. Research is continuing to assess its effectiveness against more advanced cancers. For North American men, the Ablatherm HIFU treatment is currently only available at the Maple Leaf HIFU clinic in downtown Toronto.