REVOLUTIONARY TREATMENT

High Intensity Focused Ultrasound (HIFU)

HIFU (pronounced hi-foo), or high intensity focused ultrasound, is an exciting prostate cancer treatment technology that has revolutionized the treatment of prostate cancersHIFU uses ultrasound waves to neutralize cancerous prostate cells instead of surgery or radiation which eliminates the need for an overnight hospital stay and incisions. This allows the precise targeting of the cancer within the prostate rather than bombarding the prostate gland with X-rays or removing it completely.

 

Treat Prostate Cancer Focally With No Need to Remove the Whole Gland

  • Less effect on essential nerves, blood vessels and muscles needed for erections and urinary control compared to surgery or radiation
  • Shorter treatment times and faster recovery with a one-time treatment in most cases
  • Greater precision allows our experts to destroy cancer areas while preserving the normal, uninvolved tissue
  • HIFU is an outpatient procedure, so no hospital stay is required

Since HIFU treats prostate cancer without surgery and radiation therapy, there is less of an effect on the essential nerves, blood vessels, and muscles surrounding the prostate that are critical for healthy sexual function and the maintenance of urinary continence.

This makes HIFU an excellent treatment option for men whose cancer is confined to the prostate and has not spread to other areas of the body.

In addition, HIFU offers shorter treatment times (1 to 4 hours) and faster recovery (less than 1 week) as well as, in the majority of instances, a one-time treatment option.

HIFU is also an option for men whose prostate cancer has recurred or for “salvage treatment” of cancer initially unresponsive to traditional therapies, such as hormones, surgery, and/or radiation therapy. In select patients, the procedure may even be covered by Medicare health insurance.

As pioneers of high intensity focused ultrasound (HIFU) in Los Angeles, Comprehensive Urology is proud to offer individualized HIFU treatment to our prostate cancer patients. Our team of board certified urologists has the most experience with the HIFU procedure in the area, and with the treatment of prostate cancer in general.

How does HIFU Work? 

The innovative HIFU treatment utilizes high-frequency ultrasound waves to heat and destroys/kill cancer cells within the prostate gland. The HIFU probe is inserted into the rectum which provides the easiest access to the prostate gland and, using computer imaging, placed at the precise position near the prostate gland.

The probe focuses the ultrasound waves on an exceedingly small area, no larger than a grain of rice, within the gland and heats up to almost 100 degrees Celsius in as little as three seconds. By adjusting the number of ultrasound waves and their intensity, an area of interest can be heated to a point where the cells can no longer survive.

However, since the ultrasound waves only create that degree of heat effect at the focal point of interest, the tissues outside of the treatment zone are preserved and unharmed. This is the concept behind HIFU in Los Angeles.

HIFU can be used with great precision to destroy cancers while preserving the normal, uninvolved tissue. HIFU is extremely effective and has successfully been used to treat many types of cancer worldwide.

The use of HIFU has recently been FDA-approved in the United States, and more and more men are having their prostate cancer treated with HIFU

Am I a Candidate for HIFU in Los Angeles?

Today, prostate cancer is one of the most prevalent diseases as well as the second leading cause of cancer deaths among men in the United States. The American Cancer Society estimates that 1 in 7 men will be diagnosed with prostate cancer in their lifetime.

Major risk factors for the development of prostate cancer include advancing age as the majority of men are diagnosed over the age of 65, race/ethnicity, and positive family history from a first degree relative such as a father, brother, or son with prostate cancer.

Prostate cancer screening entails both a blood test called prostate specific antigen (PSA) and a digital rectal examination (DRE) which will be performed by one our our urologists. Screening is not without controversy, and patients should have a conversation with their healthcare provider about the uncertainties, risks, and potential health benefits of this recommendation.

When diagnosed in its earliest stages, prostate cancer can be safely and successfully treated in a variety of manners including HIFU. At Comprehensive Urology, our goal is to provide the most comprehensive and patient-centric treatment for your individual prostate cancer. After all, our expert urologists understand that it is not enough to simply beat cancer, but it is equally as important to preserve a patient’s quality of life as much as possible, which is why we are proud to offer HIFU treatment to our patients.

What are the Benefits of HIFU for Prostate Cancer?

Not so long ago, prostate cancer was treated aggressively, resulting in control of the disease but also distressing side effects, such as erectile dysfunction and urinary incontinence, that negatively impact quality of life. The traditional treatments of prostate cancer have been restricted to surgery by the complete removal of the gland, which is termed a radical prostatectomy, or radiation therapy in the form of an external beam or brachytherapy (planting radiation seeds into prostate).

HIFU is an excellent treatment option for men who have been diagnosed with organ-confined prostate cancer, which by definition has not yet spread beyond the prostate gland. The HIFU procedure has many benefits over traditional prostate cancer treatments (i.e., surgery, radiation therapy, and/or hormone therapy), including the following:

  • Precise, targeted ultrasound therapy ensures that only cancer cells are affected. Ultrasound waves do not harm surrounding tissue.
  • Non-surgical Prostate Cancer Treatment: HIFU is targeted, minimally invasive, and utilizes a probe (not a scalpel).
  • Outpatient procedure: No hospital stay is required. Patients are discharged home after the procedure, which can take anywhere from 1 to 4 hours.
  • Quick recovery time: Since there is minimal to no cell damage with HIFU treatment, patients return to normal activities within a few days after treatment.
  • No blood loss: Since HIFU is non-surgical and minimally invasive, there is no blood loss.
  • Minimal side effects: Patients undergoing the procedure have greater preservation of erectile, sexual, and urinary function. In other words, greatly reduced risks for both ED and urinary incontinence have been observed.
  • Better preserved bladder control
  • Reduced risk of erectile dysfunction

High frequency ultrasound for prostate cancer treatment is an innovative, alternative approach. As a result, it is imperative that patients consult with a board certified urologist who has extensive experience and training in HIFU to ensure the most excellent treatment outcomes. At Comprehensive Urology, we counsel our patients regarding all the available medical, traditional, minimally invasive, and innovative alternative treatment options, including HIFU treatment.

Our office is one of the only practices in Los Angeles that has the expertise to offer HIFU for the treatment of prostate cancer. If HIFU treatment is deemed your optimal mode of therapy, our urologists will discuss the pros and cons and provide a customized cutting-edge treatment plan for your prostate cancer. As a result, most patients have the luxury of making an informed, confident decision with regard to their choice of HIFU.

Advantages of HIFU for Prostate Cancer
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  • Minimally Invasive: Whereas many traditional prostate cancer treatments are invasive, HIFU uses ultrasonic energy to target and destroy cancer in the prostate. Additionally, HIFU does not require the use of radiation, thereby eliminating the risk that radiation will affect healthy prostate gland tissue and any surrounding tissue.
  • Fast Recovery: There is no blood loss or similar trauma associated with HIFU, and only minimal cell damage to the prostate may occur during the procedure. Therefore, patients who choose HIFU frequently enjoy a speedy recovery in comparison to patients who undergo traditional prostate cancer treatments.
  • Reduced Risk of Sexual Impotence: Radiation therapy and hormone therapy are commonly used to treat prostate cancer, but they may affect a man’s ability to get and maintain an erection. Comparatively, the risk of sexual impotence and erectile dysfunction following an HIFU treatment is minimal.
  • Increased Bladder Control: HIFU leverages ultrasound technology to focus on diseased cells, and as such, limits the risk of bladder control issues. In fact, men often report little to no urine leakage following treatment.
  • Quick Procedure: A typical HIFU treatment takes about two hours to complete. No hospital stay is required, and the procedure is usually performed at an outpatient treatment center. Plus, most HIFU patients can return home the same day as treatment.
  • Personalized Treatment: A patient can undergo a radical or focal HIFU treatment. Prior to treatment, a urologist analyzes a patient’s prostate, along with a patient’s preferences and any past prostate cancer treatments. He or she then may treat only a certain area of the prostate or the entire prostate. This approach ensures a urologist can help each patient achieve the best-possible treatment results.


The HIFU Procedure

HIFU allows our urologists to specifically target a desired area of the prostate with great precision, thereby allowing effective focal therapy to be performed. The involved area of the prostate is determined and mapped based on MRI and biopsy results. This information is used real time, to map out the area within the prostate that needs to be treated while preserving the normal prostate tissue.

HIFU is then delivered specifically to the targeted area, thereby destroying the cancerous cells, while preserving the normal cells outside of the treatment areas. HIFU is performed as an outpatient. No incisions are necessary.

How Can You Prepare for an HIFU Prostate Gland Procedure?

A urologist helps a patient prepare for all aspects of a HIFU prostate gland procedure. He or she will provide detailed instructions about the procedure and respond to a patient’s concerns or questions prior to treatment. That way, a patient knows exactly what to expect during the procedure.

In addition to undergoing various tests to determine if a patient qualifies, a urologist may recommend dietary and lifestyle changes to limit the risk of side effects after treatment. For example, a urologist sometimes recommends a HIFU patient walk or perform lower abdomen exercises to help control the bladder and reduce the risk of urinary incontinence. Or, a urologist may recommend a patient consume antioxidant-rich foods; these foods help enhance immunity. A urologist may also recommend a HIFU patient consume protein-rich foods that promote quick healing. He or she may recommend a HIFU patient avoid alcohol and foods that may increase inflammation, too.

A patient should be psychologically prepared for HIFU as well. Prostate cancer treatments may incite fear, and a patient may want to dedicate time and resources to learn as much as possible about HIFU. With an informed approach to HIFU, a patient may be better equipped than ever before to feel confident about this prostate cancer treatment.

Bowel preparation is necessary before a HIFU procedure, and a urologist will provide instructions about how to prepare the bowel properly. A patient cannot consume any solid or liquid at least two hours before surgery. An enema may also be used to remove gut waste, and skin tests may be performed prior to treatment.

How Long is the HIFU Prostate Gland Procedure?

Only cancerous cells and tissues are treated by the HIFU process, resulting in a safe and effective treatment that preserves surrounding healthy prostate cells and tissues. This procedure is an outpatient procedure in contrast to traditional prostate cancer treatments (i.e., surgery or radiation therapy). Depending on the area being treated, the HIFU procedure can take between one and four hours to complete. Because HIFU treatment is a focal therapy technique, the urologists at Comprehensive Urology in Los Angeles are able to provide pinpoint and localized ultrasound treatment to prostate cancer cells. Prostate health and function tends to be preserved with HIFU treatment.

Additionally, the HIFU procedure has been shown to provide quicker recovery times, allowing patients to resume healthy everyday lives within a few days of treatment. The same cannot be said for traditional forms of prostate cancer treatment.

HIFU Focal Therapy

HIFU coupled with MRI perfusion dynamic of the prostate and more recent mapping techniques offers a new treatment paradigm: focal prostate cancer therapy. Focal therapy is appropriate for patients with cancer localized to less than half the volume of the prostate. In such cases, the entire gland does not need to be treated. Only the diseased areas are treated while sparing the normal prostate tissue.

This approach is very much akin to current treatment options for women with breast cancer. For most women who are diagnosed with breast cancer, the entire breast does not need to be removed. Instead, only the diseased segment or “lump” is removed. This approach is referred to as a “lumpectomy”.

HIFU, in effect, allows for a prostate “lumpectomy” to be performed, thereby preserving the remaining normal prostate tissue. Preserving the normal prostate tissue, dramatically reduces the potential for sexual and urinary side-effects. Focal prostate cancer therapy, therefore, offers excellent prostate cancer treatment results while optimizing a patient’s quality of life.

HIFU allows a physician in Los Angeles to specifically target a desired area of the prostate with great precision, thereby allowing effective focal therapy to be performed. The involved area of the prostate is determined and mapped based on MRI and biopsy results. This information is used real time, to map out the area within the prostate that needs to be treated while preserving the normal prostate tissue. HIFU is then delivered specifically to the targeted area, thereby destroying the cancerous cells, while preserving the normal cells outside of the treatment areas.

HIFU is performed as an outpatient. No incisions are necessary. The procedure typically is performed over a three hour period. Patients go home a few hours after completion of the HIFU therapy.

Results after HIFU focal therapy have shown to be excellent. HIFU focal therapy for prostate cancer can effectively eradicate cancer while preserving sexual and urinary function in a male.

How Do I Know If I Am A Candidate For HIFU Focal Therapy?

Accurate identification and localization of the cancer is key. For this reason, we use MRI imaging of the prostate and we use prostate mapping techniques when we do our prostate biopsies. With these techniques, we can accurately identify the extent and location of the prostate cancer. Once we have localized the cancer, it’s easy to treat it with HIFU.

Whole Prostate Gland HIFU Therapy

 

Men diagnosed with prostate cancer who pursue a treatment option typically undergo treatment of their entire prostate gland. The cancer removal is typically performed surgically (open, laparoscopic or robotic prostatectomy), with external beam radiation, with internal radiation, or with cryotherapy (freezing of the prostate).

While these modalities can be effective with varying success rates, all have the potential of causing erectile dysfunction and urinary dysfunction ranging from urinary frequency, urinary urgency, obstructive voiding symptoms to urinary incontinence.

HIFU is an outpatient treatment modality that can similarly treat the entire prostate gland with curative intent. As with other, above-mentioned, modalities, HIFU can be a very effective treatment modality for treating this cancer. 

However, because of its precision, HIFU can have favorable outcomes in regards to erectile function and urinary symptoms as compared to surgery, radiation therapy or cryotherapy.

Many patients who choose to have HIFU, do so with the aim of treating their prostate cancer while trying to minimize their post-treatment side-effects.

The other advantage of HIFU is that it performed as an outpatient (not requiring hospitalization). HIFU treatment for prostate cancer typically takes about 3 hours to complete.

How is whole gland HIFU performed?

Whole grand HIFU is performed if a man has been diagnosed with prostate cancer. The first step is to first make sure that the cancer has not spread outside the prostate. If the cancer is limited to the prostate, then we assess the size of the prostate to make sure it is suitable for a HIFU treatment. Smaller glands are typically better suited for HIFU treatments. The gland needs to be less than 4 cm in height and 4.2 cm in length. This assessment is done by a simple prostate ultrasound. During the ultrasound evaluation, we also make sure that there are no dense prostate stones, which can block the HIFU ultrasound waves.

If the man’s prostate is larger than the recommended dimensions for a HIFU procedure, we determine if we can shrink the size of the prostate using medications or by performing an outpatient procedure called a TURP, where the prostate size is easily reduced, allowing most men to become candidates for a HIFU procedure.

Partial Prostate Gland HIFU Therapy 

A patient can receive partial prostate gland HIFU therapy, also referred to as focal therapy, to address cancer that is confined to a portion of the prostate.

With this therapy, the area of the prostate affected by cancer is treated, and the remaining portion of the prostate remains intact.

How Does Partial Prostate Gland HIFU Therapy Work?

With focal HIFU therapy, a urologist first identifies the portion of the prostate that requires treatment. He or she uses transrectal ultrasound guidance to identify the proper treatment area and maps out the procedure accordingly.

Focal HIFU therapy is performed as an outpatient procedure under general anesthesia. During the procedure, a urologist administers HIFU sound waves to a targeted portion of the prostate. The procedure is designed to limit the impact of the sound waves on tissue surrounding the treatment area.

What Are the Side Effects Associated with Focal HIFU Therapy?

Like any prostate cancer treatment, there are side effects associated with focal HIFU therapy. These side effects include minor swelling, soreness, and discomfort, and they generally will disappear on their own shortly after treatment.

Are You a Candidate for Partial Prostate Gland HIFU Therapy?

HIFU has been shown to help many patients treat their prostate cancer symptoms, but deciding between partial or whole gland HIFU therapy can be difficult. Fortunately, our urologists help patients take the guesswork out of selecting the right prostate gland treatment.

Our urologists meet with patients, learn about their prostate cancer symptoms, and develop a custom treatment program. They also will perform a comprehensive patient evaluation and learn about a patient’s long-term prostate cancer treatment goals. Then, our urologists will help patients weigh the pros and cons of partial and whole gland HIFU therapy and other prostate cancer treatments.

HIFU Treatments For Cancer Remission

In spite of efforts to get rid of cancer, there’s a chance that, after you enter a period of remission a recurrence can occur. When cancer returns, HIFU is a treatment option for patients who have previously had radiation treatments or cryotherapy.

URINARY INCONTINENCE

FAQ

Post Radiation HIFU Treatment

Some patients who elect to undergo radiation therapy (either with external beam IMRT or with internal radiation) to treat their prostate cancer may develop local recurrence of their disease.

Historically, treating prostate cancer radiation failures has been difficult, as such patients cannot receive additional radiation therapy and trying to surgically remove a prostate after it has been radiated is very challenging and fraught with significant side effects, including severe incontinence, rectal fistulas, loss of erectile function and pelvic pain.

However, HIFU can be effectively utilized to treat patients who have failed prostate radiation therapy with relative ease and good outcomes. Using HIFU for radiation therapy failures still allows patients to achieve a cancer free status with an outpatient procedure. The prostate is mapped out and the HIFU is used to treat the residual cancer cells in the prostate. Either focal HIFU therapy or whole gland HIFU therapy can be utilized depending on the extent of the prostate cancer recurrence.

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Post Cryotherapy HIFU Treatment

While cryotherapy can be an effective means of treating patients with prostate cancer, some patients will develop local recurrence of their prostate cancer after undergoing cryotherapy.

Treating such patients can be challenging. However, HIFU provides an effective means to treat such patients. Patients with post-cryotherapy prostate cancer recurrence can also be treated with surgery (salvage prostatectomy). Compared to salvage surgery however, HIFU is less invasive, is performed as an outpatient procedure and provides less side-effects. Both surgery and HIFU can be effective in treating recurrent post-cryotherapy prostate cancers

What Are Traditional Prostate Cancer Treatments?

A: Both surgery and radiation therapy can be effective and even life-saving with regard to prostate cancer. Other options in the treatment of prostate cancer depend on the burden of the disease and may include cryotherapy or cryosurgery, hormone therapy, chemotherapy, vaccine treatment, bone-directed treatment, and watchful waiting or active surveillance – especially in men over the age of 70 with a life expectancy less than 10 years.

What are the side effects of HIFU?

Common side effects of an HIFU procedure include rectal irritation, urinary frequency and urgency, urinary retention, and urinary tract infection (UTI). These side effects may affect a patient for only a few days after treatment. In many instances, the side effects can be managed with medication.

In rare cases, HIFU patients have experienced urethral strictures, rectourethral fistulas, and infections of the pubic bone. Patients who experience any of the aforementioned side effects may require a follow-up procedure to address these issues.

How do I know if I qualify for HIFU?

A urologist performs a series of tests to determine if an individual qualifies for HIFU. Typically, HIFU candidates have a prostate gland with less than 40 grams of localized prostate cancer. Urologists will also look at a patient’s PSA and Gleason score; a patient with a PSA of 20 or less and a Gleason score of 7 or less may qualify for HIFU.

Is HIFU an effective prostate cancer treatment?

 Long-term cancer outcomes for HIFU patients are unavailable due to the fact that the procedure is still relatively new in the United States. However, some research indicates 8-20% of HIFU patients have clinically significant prostate cancer in the treated area. If a patient experiences persistent prostate cancer after an HIFU treatment, the cancer can be retreated with HIFU or other treatments.

Does HIFU target only cancer cells in the prostate?

HIFU may be used to treat the entire prostate or only a portion of the prostate. A urologist will use advanced diagnostic techniques to determine which areas of the prostate to treat during an HIFU procedure.

How does HIFU differ from brachytherapy?

Brachytherapy is a form of radiation therapy. It involves the placement of radioactive seeds inside the prostate. These seeds stay inside the prostate until the procedure is complete. They may also migrate to other organs.

Comparatively, HIFU is a radiation-free prostate cancer treatment. It involves the use of a clean energy source and can be performed multiple times if necessary. Additionally, if HIFU does not deliver the desired results, a patient can pursue other treatment options following the procedure.

How long does a HIFU treatment take?

HIFU is performed as an outpatient procedure, wherein patients do not need to be hospitalized. The procedure is performed at an outpatient facility and they go home shortly after they undergo HIFU. The duration of the HIFU procedure depends on the amount of tissue that needs to be treated. On average, a HIFU treatment will take about an hour and a half to three and a half hours.

Do I need to have a catheter after the HIFU procedure?

Placement of a catheter depends on the amount and location of the tumor that is being treated. Some patients will not need a catheter while others will need a catheter for an average of about five days.

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