What Are The Advantages Of Hifu
Advantages of HIFU include:
- It requires no surgical incisions into your body and doesnt use radiation.
- It can exactly target diseased tissue, leaving non-targeted healthy tissue unharmed.
- Its often an outpatient procedure with a short recovery time. You can usually return to work or your usual routine within a few days.
HIFU has fewer side effects than more invasive types of tumor treatment, including:
The Sonablate Hifu Procedure
The HIFU procedure typically lasts between 1-4 hours, depending on the size of the prostate, and is done under general anesthesia. During the procedure a suprapubic or foley catheter will be put into place to help with urination, and will typically stay in place for 1-2 weeks. After the HIFU treatment, patients will be in recovery for about 1-2 hours. Once released from the treatment center, patients return home to recover more comfortably. Though, it is recommended that patients take things easy, most patients feel well enough to go out for dinner and maybe even a walk, the day of the procedure.
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Will I Need Further Tests
A quarterly measurement of the PSA is recommended for the first two years, and biannual tests are recommended in years three and four.
Thereafter we recommend an annual PSA test. Three to six months after the treatment the PSA should be reduced to 0.5 ug/l.
If the PSA reading does not return to very low levels or rises, a repeat ultrasound and biopsy can be performed. If this biopsy shows residual tumor , a second Ablatherm® HIFU session can be conducted. A major advantage of Ablatherm ® HIFU is that it is repeatable and does not preclude future treatment by any other treatment options. A bone scan and CAT scan would also be ordered. If biopsies are negative but the PSA rises, additional therapy may be prescribed.
Urinary System
Narrowing of the urethra where it passes through the prostate can appear in the months following the treatment due to the scar tissue which replaces the treated prostate tissue.
This narrowing can necessitate a simple outpatient treatment called a transurethral urethrotomy to re-establish the normal urethral channel. This is a simple procedure performed by any urologist.
Will I be Incontinent?
In the patients treated with Ablatherm® HIFU approximately 1 in 50 experienced either Type 2 or Type 3 incontinence.
Type 1 incontinence is the leakage of urine with marked straining.
Type 2 is the leakage of urine with mild to moderate straining. Both types of incontinence are manageable with medications and pelvic floor exercises.
Sexual Activity
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Srt Is Still Effective And Tolerable For Patients Who Are Failure After First Line Hifu Treatment
A study by Filippo et al. intended to evaluate tolerance and acute toxicity in patients who failed to HIFU and salvaged by second line SRT. Acute grade 1 and grade 2 GU toxicities were recorded in 7/15 and 4/15 patients respectively Acute grade 1 and grade 2 bowel toxicities in 4/15 and 1/15 patients Acute grade 1 and grade 2 rectal toxicities in 3/15 and 2/15 respectively. No grade 3 or greater acute or late toxicities occurred . In another study to treat patients with SRT after HIFU failure, Fernando et al. found that GI toxicity was low. Acute GU toxicity grade II rate was 45.8%. With only a few patients presenting grade III and grade IV toxicity. Late grade III GU toxicity was registered in 16.7% of patients. The 3-year disease-free survival rate was 77.8% . Julien et al. also evaluated the tolerance and oncologic control with salvage radiotherapy after HIFU failure. For the 83 patients treated with exclusive radiation therapy, PFS was 72.5% at 5 year. GI toxicity was low GU toxicity grade 2 was 34.5%, grade 3 , grade 4 , and grade 5 . The incidence of severe ED was 14% pre-HIFU, and 51.9% and 82.3% pre-and post-SRT, respectively .
These studies suggested that SRT still provides satisfactory oncologic control and with little additional toxicity even after HIFU failure.
When Is Hifu Treatment Used
HIFU can be used to treat the whole prostate gland when the cancer is in more than one area. It is also used when there is only one small area of cancer in the prostate gland .
If there are areas of cancer that are growing quickly you can have focal treatment to these. Very slow-growing areas of cancer may not be treated. You may have fewer side effects because less healthy tissue is damaged.
If the cancer comes back after HIFU treatment, you may still be able to have treatment with surgery or radiotherapy. You will have your PSA level checked regularly after treatment.
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How Does It Work
Our HIFU system captures real-time images of the prostate, allowing the doctor to create a customized treatment plan for each patient. Once the treatment plan is mapped, the doctor delivers the ultrasound energy to targeted sites, or focal points, throughout the prostate gland.
HIFU treatment is focal, meaning that the ultrasound heat only destroys the unhealthy tissue, leaving the healthy part of the prostate intact.
Hifu As Alternative Therapy For Prostate Cancer
In 2015, the FDA approved high-intensity focused ultrasound as a surgical tool for the destruction of prostate tissue . While the current evidence for whole-gland HIFU ablation suggests that its clinical efficacy and adverse events are similar to current definitive therapies, short-term data suggest that focal therapy could reduce the rates of side effects from prostate cancer treatment.
We know that, historically, weve overtreated patients with prostate cancer, said Kristen Scarpato, M.D., assistant professor of urology at Vanderbilt. We now appropriately enroll more patients for active surveillance. However, some patients who are not ideal candidates for surveillance may benefit from HIFU. Others may actually be harboring a clinically significant disease that has not yet been diagnosed.
Scarpato is leading Vanderbilts entry into HIFU as an alternative therapy for patients with low-to-intermediate risk prostate cancer. HIFU fits somewhere between observation and aggressive therapy, Scarpato explained. Its a balance between oncologic control, treatment harms and quality of life.
HIFU fits somewhere between observation and aggressive therapy. Its a balance between oncologic control, treatment harms and quality of life.
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The Value Of Bicalutamide 150mg In The Treatment Of Localized Pca
Bicalutamide is a competitive androgen receptor antagonist that inactivates androgen-regulated prostate cell growth and function, leading to cell apoptosis and inhibition of PCa growth. With an average follow-up of 7.2 years, William et al. found that bicalutamide 150mg plus curative radiation had significantly clinical benefits in terms of OS, PFS and PSAPFS compared with radiotherapy alone with locally advanced PCa . See et al. demonstrated bicalutamide 150 mg significantly reduced the risk of PSA progression, irrespective of whether patients had received radical prostatectomy or radiotherapy as standard care . After a median follow-up of 9.7 years, Iversen et al. analyzed the Early Prostate Cancer program. This program recruited 8113 patients, among them 4052 patients were randomized to bicalutamide 150 mg and 4061 patients to placebo, in addition to standard care of RT, RP or watchful waiting . At the time of data cut-off, 3032 patients met the criteria for objective disease progression among them 1483 patients in the bicalutamide and 1549 patients in the placebo group. In the WW group, the median PFS was 6.6 years for patients randomized to receive bicalutamide 150mg compared with 3.7 years for those who randomized to placebo. In addition, bicalutamide reduced the risk of death by 30% in patients with locally advanced disease received RT compared with placebo .
Prostate Cancer Patients Are Paying Hefty Price For Controversial New Treatment
Men hoping to avoid some side effects of prostate cancer treatment are shelling out tens of thousands of dollars for a procedure whose long-term effects are unknown and insurers, including Medicare, wont pay for.
Proponents say high-intensity focused ultrasound can have fewer negative side effects than surgery or radiation, while giving some patients another option between actively watching their cancer and those more aggressive steps. Critics, however, say the procedure is being oversold, leading some patients to get a treatment they dont need.
Device makers are busy selling the $500,000-and-up machines to doctors around the country and offering training courses. Billboards advertising this new non-invasive treatment for prostate cancer are springing up, while treatment center websites promise a safer method with benefits such as no erectile dysfunction and no incontinence, although studies show those side effects can occur, but less often than with other types of more aggressive treatments. The treatment can range in cost from $15,000 to $25,000.
HIFU is the latest treatment to prompt concerns over whether there should be limits such as requiring tracking of results placed on expensive new technology while additional data is gathered.
In the U.S., advisory committees to the Food and Drug Administration twice turned down applications from manufacturers to market HIFU devices as a treatment for prostate cancer, citing not enough long-term evidence.
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High Intensity Focused Ultrasound
Now patients have another option for treating prostate cancer besides radiation or surgery. HIFU is minimally invasive, and patients can go home the same day. The treatment is highly focused, sparing surrounding tissue and reducing the risk side of effects such as incontinence and erectile dysfunction.
Different Side Effects Between Hifu And Radiotherapy As Salvage Therapy For Recurrent Pca
A small number of studies have shown that HIFU as first-line salvage therapy after RP has obtained satisfactory results and tolerable side effects. In Asimakopouloss study, no case of urethrorectal fistula or anastomotic stricture was observed. Two cases of acute urinary retention were resolved with prolonged urethral catheterization. Four cases of stress urinary incontinence were observed 2 were resolved after pelvic floor exercises within 6 months, while 2 cases of severe incontinence required surgical minimally invasive treatmen17. Palermo et al. reported 22% stress urinary incontinence occurred after HIFU treatment. Two sevenths of the patients complained about erectile dysfunction after HIFU treatment. They did not observe cases of urethrorectal fistula or persistent lower urinary tract symptoms .
Thus, salvage HIFU and salvage radiotherapy have different side effects as local therapy in recurrent PCa. However, it should be noticed that SRT is the mainstream in current studies, and salvage HIFU need more time to accumulate acute and long-term safety data.
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Is Hifu Covered By Insurance
HIFU is covered under Medicare, which has approved treatment reimbursement under a C-code for hospital outpatient department services and procedures. Coverage under private insurance varies, so contact your provider for more information. The American Medical Association has begun the process of establishing a CPT code for HIFU, which means that private insurers will be more likely to reimburse for the procedure, starting January 2021.
How Does High Intensity Focused Ultrasound Work
HIFU destroys prostate cancer through the delivery of precise and focused sound waves to a targeted spot of diseased prostate tissue. This technology uses ultrasound energy, not radiation, to destroy the targeted tissue. The Ultrasound energy, or sound waves, is transmitted through the rectal wall and focused at desired locations within the prostate identified by MRI and confirmed by ultrasound. This targeted and minimally invasive approach to treating prostate cancer leaves the healthy tissue untouched and unharmed and minimizes the chance of side effects.
The basic concept of how HIFU targets, burns and destroys specific prostate tissue is similar to how a magnifying glass can use the suns rays of light to burn a precise hole in a leaf at the point of intersection. Similar principles apply to HIFU. Instead of using light as the source of energy, HIFU uses sound, and instead of a magnifying glass, HIFU uses a transducer. The sound waves that are aimed at the prostate tissue, rapidly increase tissue temperature, destroying only the cancerous lesions and protecting the healthy surrounding tissue.
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Application Of Hifu In Treatment Of Pca
When HIFU is used for the treatment of PCa, it needs to place a high-power probe in the rectum or urethra to generate acoustic energy focused on the tissue target, which non-specifically ablates tissue through hyperthermia and mechanical effect . The thermal effects are achieved by heating local tissues to 60°C or higher , resulting in near-instantaneous coagulative necrosis and cell death . The mechanical effects include cavitation, microstreaming, and radiation forces . The mechanical effect would cause cell membrane disruption and then form the cavity, leading the tissue ablation .
In conclusion, though lack of high-quality studies currently, HIFU is a promising method to achieve local tumor control and may be a useful salvage treatment option in recurrent PCa.
What Are The Advantages Of High
Advantages of high-intensity focused ultrasound include:
- It requires no surgical incisions into the body and doesnât use radiation.
- It can exactly target diseased tissue, leaving non-targeted healthy tissue unharmed.
- It is an outpatient procedure with a short recovery time. You can usually return to work or normal life in about 24 hours.
- It reduces the risk of urinary incontinence and erectile dysfunction compared with surgery or radiation therapy.
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Who Qualifies For Hifu
Ideal candidates for HIFU are those who have early stage , low-grade cancer that is confined to the prostate, and that is visible on an MRI or ultrasound. A PSA level below 20ng/mL is also preferred. HIFU is used to treat a single tumor or part of a large tumor and is not meant for those whose cancer has spread beyond the prostate. If you are interested in HIFU, please contact the Mount Sinai Department of Urology at 212-241-9955.
What Happens After Treatment
After treatment, patients are followed closely by their Urologist in a regimen akin to active surveillance. This consists of a PSA blood test every 3-6 months, prostate exam, and prostate imaging/biopsy every 1-3 years. If prostate cancer is present within or outside the treated area, retreatment can be offered as indicated. Patients are monitored for the side effects noted above, with interventions as required to help manage these.
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What Is The Recovery Process
During the first several weeks after the procedure patients typically experience urinary symptoms such as frequency and/or urgency to void. In the first one to two months patients may pass small amount days of blood, old prostate tissue or mucus-like material in the urinary stream. A urinary catheter is inserted and typically stays in your bladder for 2 weeks. Unlike catheters used after radical surgery, it does not go through the urethra so its far more comfortable and carries a much lower risk of infection. Dr. Pugach and his HIFU team will explain all of this to you in more detail when you come in for your consultation.
Prostate Cancer Hifu Treatment Patient Success Story
John Brannan is one of the success stories. In 2016, when he was 65, his prostate-specific antigen began rising steeply. Although prostate cancer is largely not hereditary, he was alarmed because his father, uncle, and two cousins all died from the disease. A doctor in Boston suggested surgery to remove the cancer as soon as possible. But that night at a dinner party, John spoke with two of his wifes friends who had surgery for prostate cancer and discussed some of the side effects that had persisted. One friend knew about the clinical trial and connected John with MSK medical oncologist Howard Scher, who referred him to Dr. Ehdaie.
John was eager to enroll. In addition to personal reasons for wanting this treatment, I also hoped to help the next generation who might benefit, he says. Ive seen the effect this disease can have on my own family.
John Brannan, with wife Lita, called the HIFU treatment a phenomenal use of technology.
John says the process was easy. Dr. Ehdaie scheduled the MRgFUS treatment in the Center for Image-Guided Interventions at Memorial Hospital in September 2016. John walked out several hours later and went back to the hotel with his wife and had dinner. It was pretty much back to normal right away, he says. No cutting, no stiches, no lying in a hospital bed for days or weeks. I wore a catheter for the first 24 hours and was a little tired, but that was it. The treatment was actually less painful than the biopsies I have had.
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Who Can Have Hifu
HIFU might be suitable for you if your cancer hasnt spread outside your prostate and has been classed as either CPG1 or CPG 2 / CPG 3 for how likely it is to spread to other parts of the body.
HIFU is sometimes an option if your prostate cancer has started to break out of your prostate, has spread to the area just outside the prostate or has a high risk of spreading. But your cancer may be more likely to come back after treatment than in men with localised cancer.
HIFU isn’t an option if your cancer has spread outside your prostate to other parts of your body .
HIFU can also be used to treat cancer that has come back after previous HIFU or radiotherapy . This is called salvage HIFU.
HIFU may not be suitable if you have a large prostate. Focal HIFU may still be an option if the areas of cancer are close enough to the probe for the ultrasound to treat. Your scan and biopsy results will show whether this is the case. Whole-prostate HIFU may still be an option if you have another treatment, such as a transurethral resection of the prostate , laser treatment or hormone therapy, to shrink the prostate first.
In the UK, HIFU is only available in specialist centres in the UK or as part of a clinical trial. This is because it is newer than some other treatments, so we dont know how well it works in the long term.
Read more about other treatment options for prostate cancer.