We asked Dr. Cary Robertson, M.D. from Duke University Medical Center three questions on the latest development of a new medical technology that gives urologists a more precise method for treating prostate cancer.
Q1: Can you start by explaining why High Intensity Focused Ultrasound (HIFU) is an important option for treating the prostate?
A: More often than not, men with prostate cancer are offered standard choices for treatment including active surveillance, radiation therapy or surgery.
Active surveillance is especially difficult for patients who have been told they have cancer, even if it’s contained within the prostate. Urologists will typically monitor a patient with low grade disease since this prostate cancer is slow growing and may not progress. Some patients may prefer to seek treatment, however, and not risk waiting.
If a patient is diagnosed early, with intermediate or high risk prostate cancer confined to the prostate, most urologists recommend radical surgery or radiation therapy. Radical prostatectomy involves removing the entire prostate whereas radiation therapy treats the whole gland in place, but both treatments may cause side effects, including urinary incontinence and erectile dysfunction.
There is a new treatment urologists in the U.S. are beginning to use to treat selected cases of prostate cancer. It’s called High Intensity Focused Ultrasound (HIFU) and it is FDA approved (October 2015) for prostate tissue ablation. HIFU bridges the gap between active surveillance and radical treatments, allowing patients to maintain their quality of life with minimal morbidity and potentially fewer side effects. This is particularly true if only a focal area of the prostate is ablated. Q2: How does Focal HIFU work?
A: HIFU uses a minimally-invasive probe placed in the rectum, a natural orifice. There are no incisions or needles required. It can target only a part of the prostate without damaging other surrounding structures. These structures include neurovascular bundles that bring nerve and blood to produce an erection, and the urinary sphincter muscle, which controls the release of urine from the bladder.
HIFU preserves the patient’s quality of life with diminished side effects of urinary incontinence and erectile dysfunction and lower overall complication rates. It is an ambulatory procedure with a rapid recovery with less time away from work and leisure activities.
Similar to a breast lumpectomy, where the surgeon removes only the part of the breast containing cancerous tissue, urologists can use Focal HIFU to target the exact location of a suspicious area within the prostate, destroy it, sparing the remainder of the gland.
Q3: In October, 2017, EDAP TMS Inc. received FDA clearance for Ablatherm Fusion. What advantages does this new feature offer urologists?
A: This technology fuses ultrasound images with MRI images and/or 3D biopsy findings. Doctors can then view the integrated 3D images on a monitor. That image fusion enables surgeons to focus ultrasound waves with precision to ablate the specific area detected by MRI and confirmed with biopsy.
Because this new fusion capability allows for better targeting of the intended area, treatment planning with appropriate safety margins can be more precise. This additional precision could help doctors avoid damaging healthy tissue adjacent to and within the gland. This is the main reason patients undergoing HIFU procedures can experience fewer side effects.
Cary N. Robertson, M.D., is Associate Professor, Division of Urology, at Duke University Medical Center, Durham NC USA, Consultant, EDAP TMS Inc.