HIFU – Latest News

Did you know that prostate cancer is the second leading cause of male cancer deaths after lung cancer? Most men have few if any symptoms of prostate cancer. How will you learn about your situation. Will it be too late?

One of the biggest misconceptions about needle biopsies is that they spread the cancer. This is simply false. Another misconception is that prostate cancer is best treated by cutting it out. This too is false

What else should you know about prostate cancer? You should know you have choices for treatment and we’ve dedicated a page on our main site that gives users a list of items on what the everyday person should know about prostate cancer.

Check it out today and give us a call if you’ve been diagnosed with prostate cancer to learn the facts and discuss your options.

There are four recognized definitive treatment options currently offered for localized prostate cancer,HIFU, cryoablation, radiation and robotic surgery. The best treatment outcomes after any one of these options is in men that have only truly localized prostate cancer, or cancer localized to the prostate and not outside the prostate. The survival benefits for localized prostate cancer after anyone of these treatment options are similar. However, the complication rates for these four options are quite different and warrant scrutiny.
The majority of prostate cancers are now found in men through screening with the finding of an abnormal total PSA (prostatic specific antigen) and/or %free PSA.
Other than this abnormal blood test, most men are relatively asymptomatic with no findings on digital rectal examination (DRE).
The diagnosis of prostate cancer can ONLY be made through a needle biopsy of the prostate and examining the tissue. The biopsy follows a sextant pattern whereby the prostate is divided into six zones,base, middle, apex of the prostate,right and left and each of those regions is randomly biopsied.
The results of the needle biopsy ( with particular attention to the volume of the prostate cancer in each of these needle biopsy cores and their Gleason score), in addition to the PSA and stage of the prostate cancer, are used in assessing a man’s risk for progression of his cancer. Also, the patient would do well to have the biopsy results validated through an independent reference laboratory to confirm not only the presence of the cancer but the volume and the Gleason score.
In addition to the forgoing, we would factor in a patients age and co-morbidities before suggesting treatment.
The following risk categories are considered:
LOW
PSA less or equal to 10ng/ml
Gleason score less or equal to 6
Stage T1,T1c,T2a
the risk is higher if greater than 50% of the cores are positive

INTERMEDIATE
PSA between 10 and 20ng/ml
Gleason score 7 (risk is greater for 4+3 compared to 3+4)
Stage T2b, T3a
the risk is higher if greater than 50% of the cores are positive

HIGH
PSA greater than 20ng/ml
Gleason score 8-10
Stage T3b

Of these three RISK CATEGORIES, the majority of LOCALIZED prostate cancers are found in the LOW to INTERMEDIATE RISK GROUPS.
How then can we assess the patients further (other than with imaging studies such as bone scans,CT and MRI scans) so we can prevent men from having treatment for presumed localized disease when the cancer may not be localized and already outside the prostate. The best method is to biopsy the MARGINS or the limits/edges of the prostate. If these margins are clear we can be fairly confidant that the prostate cancer is indeed localized and treatment would be ideal with a minimally invasive option such as HIFU.
MARGINS
After return of the validated biopsy report, I will look at where the cancer was found in the prostate, the tumor volume and the Gleason score. If there is significant cancer volume at the base (close to the bladder/seminal vesicles) or apex (close to the urinary sphincter) of the prostate or there is a Gleason score 7 or higher in these areas, I will have the patient undergo a biopsy of the MARGINS of his prostate. This may mean an additional biopsy but the importance of this step is outweighed by the possibility of preventing a man from having a treatment that may not be in his best interests. It is pointless subjecting a man to a treatment option that is ideal for LOCALIZED prostate cancer when the cancer is not really localized. For example, in addition to the considerable risks associated with debilitating surgery ( including robotic prostatectomy) with incontinence and impotence, 20-40% of the men treated in this manner will have positive margins (or cancer left behind) necessitating the need for additional treatments such as radiation.
Should biopsies of the prostatic margins show cancer infiltration and therefor a cancer no longer localized to the prostate, the patient is probably better served by radiation. Although radiation is associated with an increased risk for longterm bowel and bladder dysfunction, this treatment option may be a better choice for those men where there is infiltration of cancer at the margins (and particularly in the apical region ) of the prostate as, radiation, by being somewhat imprecise usually also directs treatment outside the confines of the prostate. However,for truly localized prostate cancer disease HIFU appears ideal as it is very precise as well as offering cure with a low risk for longterm complications and not at the expense of quality of life (QoL).

A prostate needle biopsy result indicating a 5% or less of a Gleason 6 prostate cancer in one needle core only is termed a micro-focal prostate cancer
The diagnosis MAY be accurate after a standard 12 core needle biopsy and represent a very small volume of prostate cancer BUT it may also represent a mis-diagnosis in either presence or amount of cancer.
First, there is some concern as to whether the diagnosis was made correctly as there is some discordance between pathologists in cancer detection because of subjectivity issues. Second,the biopsy diagnosis may under represent the true status of the man’s prostate cancer. However, the greatest tragedy in the management here would be in treating a man for a non validated assumed microscopic focus of prostate cancer when he did not really have it, or, to treat a minuscule amount of prostate cancer that had little risk of progression.
The monitoring of a man with an initial validated micro-focal prostate cancer can be somewhat involved as monitoring for disease progression is not reliable by simply following the PSA, free and percent free PSA or the PCA3. Reliable monitoring can only be done with further biopsies.
In my practice, if a man presents with a validated diagnosis of a micro-focal prostate cancer, I will have him undergo a saturation biopsy under outpatient sedation and taking four cores from each sextant of the prostate (24 cores) 2 – 3 months later.
This process is to ensure that we are not missing the possibility of more significant disease that will require therapy. After my pathologist has delivered his report I will have the biopsy slides submitted to a reference laboratory for another reading and validation of the findings. Ideally, we want this validation undertaken without the benefits of previous reports so that the review is truly independent, blind and not clouded by the opinions of others.
Again,validation is important in the field of prostate pathology as in my experience there can be quite a discordance between pathologists as to not only the amount of cancer present or as to the Gleason score but also as to whether it is even present. This is despite the use of special immuno-histochemistry stains. Also,we have even seen the same pathologist provide a different reading on the same set of slides months later. Of-course,none of this is cause for comfort.
If the validated pathology reading after the saturation biopsy indicates once more the presence of a micro-focal prostate cancer OR no cancer,I will repeat a saturation biopsy 6 – 12 months later. Commonly, however, I cannot confirm the presence of a micro-focal prostate cancer on a saturation biopsy after it having been diagnosed previously. Vanishing cancer?
If the validated reading indicates on the report that there is more significant cancer in terms of tumor volume and or Gleason score, I will review the definitive treatment options of HIFU, cryoablation, radiation and surgery for localized prostate cancer with the patient and his spouse.
Relegating a man to a definitive treatment on the basis of one prostate biopsy suggesting a micro-focus of prostate cancer is clearly premature,potentially harmful and especially questionable as commonly,the existence of a micro-focal prostate cannot be confirmed on a repeat saturation biopsy. Furthermore, those prostate cancer treatment data bases that include patients with non validated T1c micro-focal prostate cancer may have outcome data skewed towards more favorable outcomes than data bases that are much more discerning. Such favorable results are obviously suspect as some of those men diagnosed with micro-focal prostate cancer may never have had the cancer in the first place.
In summary, men and their partners would do well to be very proactive and become informed and empower themselves with knowledge so they can understand their biopsy reports,their treatment options and the associated quality of life (QoL) issues. This knowledge can prevent them from being subjected to over treatment as well as to unnecessary treatment.
There appears to be NO need to rush into a treatment option for even a validated micro-focal prostate cancer as in some men the natural history of this disease is yet to be determined.

When reviewing the treatment options for LOCALIZED prostate cancer you should study the complications associated with these individual treatment options. Especially so since the SURVIVAL BENEFITS of the four standard treatment options, HIFU, cryoablation,radiation and surgery are SIMILAR but the incidence of their complications are very different and these COMPLICATIONS affect not only the patient but the spouse and their partnership.
In addition, you should review the respective benefits of these four treatment options and also realize prostate cancer can be cured without the prostate having to be cut out through radical/robotic prostatectomy.
In that regard,minimally invasive HIFU is a clear leader as a treatment option for localized prostate cancer with many upsides and very few downsides.
The following HIFU benefits are listed:
> can cure localized prostate cancer
> can cure without sacrificing quality of life (QoL)
> low incidence of side effects and complications
> truly minimally invasive with no overnight hospitalization
> non surgical (no incisions)
> quickest recovery with men ambulating at home within hours of the procedure
> no Foley catheter (no tube in penis)
> most precise of all treatment options
> real time monitoring of neuro-vascular bundles and urinary sphincter helps preserve erections and urine control.
> non radiation. HIFU is clean acoustic energy
> no blood loss
> unlike radiation or cryoablation, HIFU results in expulsion of treated cancerous prostate tissue
> no penile shortening ( the trifecta of complications associated with surgery are: urinary incontinence,impotence and penile shortening)
> treatment is repeatable
> HIFU is ideal for prostate cancer recurrences after surgery, radiation and cryoablation

It is important for the patient and his spouse to do their homework on treatment options for localized prostate cancer. Get the facts on these treatment options and the benefits of HIFU and get it right the first time.
Do NOT let yourself become another miserable statistic with permanent debilitating urinary incontinence and/or impotence after a radical/robotic prostatectomy.

Most men are asymptomatic when first diagnosed with prostate cancer and not only do they expect to survive but they expect to be cured without sacrificing their quality of life (QoL).
Since the four broad categories of definitive treatment options for localized prostate cancer (HIFU,CRYO,RADIATION and SURGERY) result in similar survival benefits, it is very important for the man and his spouse to have a clear understanding of treatment complications associated with these four categories of treatment as well as their impact on QoL issues. These treatment complications and resulting QoL issues can, not only impact the patient, but the wife and partnership as well.
Unfortunately,most urologists are unable to provide an unbiased discussion in counselling patients about the various treatment options since they lack the appropriate training in these treatment options. Fortunately,the Internet is available and the patient and family can mine it for information.
An issue of fundamental importance to the patient and his wife is the understanding that prostate cancer is easily cured WITHOUT the need for surgery whether it be robotics or conventional. Furthermore,suggestions that certain locally advanced prostate cancers should be debulked by surgery/robotics before additional adjunctive treatments are, not only merit less but harmful.

In terms of treatment complications and QoL impact,several issues are evident:
> men who underwent radical/robotic prostatectomy had a significant incidence of urinary complications.
> men who underwent radical/robotic prostatectomy had a significant incidence of sexual complications.
> men who underwent radical/robotic prostatectomy had the greatest incidence of secondary surgeries to correct complications.
> men who underwent radical/robotic prostatectomy had a high incidence of positive surgical margins with cancer left behind.
> men who underwent radical/robotic prostatectomy had a high incidence of penile shortening.
> men who underwent radical/robotic prostatectomy had a higher incidence of Peyronies disease than those that did not have surgery.
> men who underwent radiation/seeds had a significant incidence of long term bowel,bladder and sexual dysfunction.
> men who underwent radiation with the addition of long term androgen deprivation therapy (ADT) found that their QoL was further negatively impacted.
> treatment related complications and QoL issues were greater with older patients,those with high PSA’s and with the obese.
> Hispanics and Afro-American men were overall less satisfied in dealing with complications.
> spouses and partners are directly affected by the treatment complications as well and their QoL is impacted negatively.

Surprisingly,the treatment options for localized prostate cancer that have the greatest incidence of complications have never been required to prove themselves through FDA trials. Yet, the non surgical, non radiation, outpatient high intensity focused ultra sound (HIFU) therapy, also a definitive procedure for localized prostate cancer, is undergoing an FDA trial. Although HIFU is available world wide,it is presently only available in the US in certain select study sites under certain conditions. This scenario is the reason we travel to provide this state-of-the-art treatment.
A man and his spouse should know their treatment options for localized prostate cancer and also know the complications that result from these treatments as well as their effects on QoL.
” IN FACT,THE ONLY TIME I HAVE EVER HEARD A MAN SAY THAT SURGERY WAS THE WORST DECISION OF HIS LIFE WAS AFTER A RADICAL/ROBOTIC PROSTATECTOMY.”
Localized prostate cancer can be cured without sacrificing QoL. Get it right the first time and get it from an expert.