Why HIFU for Prostate Cancer Treatment?

By Janice Lee Arnold, MD

Most men are well aware of their potential to develop prostate cancer with aging. It’s not at the top of your checklist at age 40 years. However, by the time you’re 45-50 (for African American men) and 50-55 (for white American men), your primary care physician is recommending a prostate-specific antigen (PSA) blood test, and a digital rectal exam (DRE). It’s no fun by any means, but cancer detection and treatment for most men can truly save lives. So if that’s the case, why wouldn’t all men be running to their physicians or healthcare providers at lighting speed to get this done?

Well, the word is out, the prostate biopsy performed to detect cancer is no cakewalk and prostate cancer treatment side-effects can be devastating. Fortunately, much has changed over the last few years. This is not your father’s prostate cancer and it is certainly not your father’s treatment. We are understanding so much more about this disease and it is allowing for a more personalized approach to treatment.

High-Intensity Focused Ultrasound (HIFU) is the focal treatment of prostate cancer without surgery and without radiation. It uses therapeutic ultrasound waves that pass through human tissue at such a rapid rate that it heats the prostate and destroys the cancer. The entire prostate can be treated or instead, smaller portions of the gland where the cancer is located can be treated with fewer side effects. It is done with such precision, that often penile erectile function and urinary bladder function remain intact. The treatment is as effective as surgical removal or radiation therapy. However, it is outpatient, with anesthesia, and performed in under 1-1.5 hours on a Saturday morning. Usually, narcotic pain medications are not required afterward.

A requirement of any successful treatment of prostate cancer is having a better understanding of the locations of cancer within the gland. Undergoing a freehand Transperineal prostate biopsy or MRI-Fusion prostate biopsy are the better methods used to detect specific cancer sites within the gland. As the first urologist in the state of Virginia to adapt the freehand transperineal biopsy, I can quickly attest to its usefulness in more accurately locating cancer within the prostate. No detection tool is 100% accurate but transperineal biopsy gets us close. It not only helps map out the cancer locations but also samples areas of the prostate gland that may be difficult to reach with ordinary transrectal prostate biopsy. These newer methods of prostate biopsy can also be performed awake, or with IV sedation and therefore rendered completely painless.

Call our office if you are interested in these more recent, efficient, effective, state-of-the-art tools for the detection and treatment of prostate cancer. Transperineal and MRI-fusion prostate biopsy are the way to go to detect prostate cancer and HIFU treatment will provide a curative, comparable result to surgery and radiation with far fewer side effects. It is time we treat prostate cancer as breast cancer has been treated for years, many patients can receive focal therapy instead of total gland therapy with enduring results, great post-treatment outcomes, and with fewer side effects.