Wednesday, December 7, 2022

High Intensity Ultrasound Prostate Cancer

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Hifu Provides An Alternative

High Intensity Focused Ultrasound for Prostate Cancer

When a patient is diagnosed with prostate cancer that has not spread beyond the walls of the prostate, there are three ways to manage the cancer. The first is watchful waiting or active surveillance. Often, prostate cancer grows slowly and is nonaggressive. The cancer may not impact the patient during his lifetime. Despite the slow progression of this disease, some patients are still uncomfortable with a diagnosis of cancer and prefer treatment. The second option is complete surgical removal of the prostate, or radical prostatectomy. The third option is radiation therapy which requires multiple rounds of radiotherapy over several months. Both surgical removal and radiation have been the standard of care for many years.

For men diagnosed with localized prostate cancer, HIFU provides another alternative. HIFU is a minimally invasive, outpatient procedure. No incisions are made during treatment. Think of holding a magnifying glass above a leaf on a sunny day. The suns rays shine through the lens and cause the leaf to burn. The procedure is precise and effective.

Questions To Ask Your Doctor Or Nurse

  • What are the advantages and disadvantages of HIFU?
  • Where is this treatment available?
  • Can I see the results of HIFU treatments you have carried out?
  • What are my other treatment options?
  • Will I have focal HIFU or whole-prostate HIFU?
  • What are the side effects of HIFU? How likely am I to get them?
  • How can I manage any side effects I get?
  • How will I know if the treatment has worked?
  • How likely is it that Ill need more treatment after HIFU?
  • What treatments are available after HIFU?

What Happens Before A Hifu Procedure

In most cases, youll need to undergo an imaging test, such as an MRI or ultrasound, before the HIFU procedure. This will help your healthcare provider find the exact location of the tissue they want to target.

Your provider will give you specific instructions to prepare for the HIFU procedure. Be sure to follow them.

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What Does Hifu For Prostate Cancer Treatment Look Like

Before starting the HIFU treatment, it is important to ensure that the bowels are empty. Therefore an enema is given before the procedure, and eating and drinking must be avoided for at least 6 hours. General/ spinal anesthesia is used for maximum comfort.

  • You will be asked to lie on the right-hand side of the urologist as he inserts a finger-sized gel-coated ultrasound probe into your rectum and positions it to your prostate level.
  • An imaging transducer in the center of the probe scans your prostate and creates a three-dimensional computerized image of your entire prostate and the area to be treated.
  • After a thorough analysis, the urologist creates a precise plan of action, which is implemented through focused ultrasound beams on the targeted tissue.
  • One beam lasts for around 20 seconds and kills about a rice grain size of the tissue at a time. Therefore a series of beams are targeted until all the diseased tissue is destroyed.
  • The procedure takes around 2-3 hours but depends upon the tissue size that needs treatment.
  • The HIFU machine has many safety checks, which are continuously monitored throughout the procedure to ensure your safety.

What Are The Side Effects

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HIFU has fewer side effects than many other treatments for prostate cancer.

After HIFU, you may have trouble getting an erection, but this usually goes away in time, and medicine can help while you regain this ability. Some men also have trouble peeing or may leak urine between trips to the bathroom.

Other side effects include pain between your testicles and your rectum, which can often be handled with medication. There’s also a risk for blood in your urine, a urinary infection, and an infection in your testicles. Always call your doctor right away if you have signs of any of these.

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Why It Is Done

This treatment helps to treatment prostate cancer. It may be used with other treatments or used by itself. The benefits of this treatment include:

  • It is typically performed on an outpatient basis
  • There is no radiation used with this treatment
  • The side effects are limited
  • There is no blood loss or surgery needed for HIFU
  • The treatment is targeted and personalized

This treatment can be done on specific areas to target cancer or it can be performed on the whole prostate. HIFU might be considered if your prostate cancer is a recurrence or if the cancer is newly diagnosed.

Hifu And Clinical Trials

HIFU is not available in every hospital. Your doctor might offer you HIFU treatment as part of a clinical trial. Or you might need to travel to specialist centre for treatment.

  • Focal therapy using high-intensity focused ultrasound for localised prostate cancerNational Institute for Health and Care Excellence , 2012

  • A multicentre study of 5 year outcomes following focal therapy in treating clinically significant non metastatic prostate cancerS Guillaumier and others

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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.

Making Hifu Available For More Patients

How High Intensity Focused Ultrasound Treatment Works for Prostate Cancer Works

Dr. Ehdaie says that using MRgFUS for intermediate-risk cancers became possible due to two important developments over the past 15 years. First, there was an acceptance by experts of using active surveillance for low-grade tumors. The second advance was new imaging technology that enabled MRIs to be incorporated into ultrasound treatment.

In the phase 2 clinical trial, 101 men received the novel MRgFUS treatment and then were biopsied six months and 24 months later. There was no intermediate- or higher-risk cancer left in the treated area for 88% of the patients.

Probably most important was the lack of side effects, Dr. Ehdaie says. Nobody in the study reported urinary incontinence or experienced bowel problems. Most men were able to achieve erections.

Based on this data, the FDA in December 2021 granted approval for the technology, called Exablate Prostate, to treat prostate tissue. The FDA also approved an investigator-initiated trial designed by Dr. Ehdaie and surgeon Peter Scardino to compare MRgFUS focal therapy to active surveillance and demonstrate a clinical benefit for patients with prostate cancer.

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Salvage Hifu For Recurrence After Radical Prostatectomy

18
  • G, Gleason mo, months ND, not determined Rd, radiation therapy.

The European Association of Urology guidelines defines relapse after local therapy as PSA values > 0.2âng/mL after radical prostatectomy and > 2âng/mL above the nadir after radiation therapy. Therapy for PSA relapse after radical prostatectomy includes salvage radiation therapy for PSA levels < 0.5âng/mL and salvage radical prostatectomy or cryoablation of the prostate in radiation failures is recommended. HIFU might be an alternative salvage therapy for patients with local recurrence after RPx. Salvage HIFU for patients with local recurrence after radical prostatectomy is feasible, even when patients have previously received salvage radiation therapy. However, a larger number of cases will be needed to further study the effectiveness of HIFU and to evaluate any possible adverse effects.

Salvage Hifu After Radiation Therapy

Men who undergo EBRT or interstitial brachytherapy for clinically localized prostate cancer have a 20â30% chance of experiencing PSA failure.-

Patients with biochemical recurrence after radiation therapy might experience a local recurrence, metastatic disease, or both. Ruling out distant metastases is difficult as a result of the poor sensitivity of bone scanning, abdominal CT or pelvic MRI for identifying bone and lymph node involvement. Patients thought to have localized recurrence after radiation therapy have historically been subjected to salvage radical prostatectomy, androgen ablation therapy or observation. These methods show varying degrees of success and toxicity that are aptly summarized in several recent systematic reviews.- These reviews report that surgery, brachytherapy and cryotherapy showed cancer control rates of 31â83%, 20â89% and 18â74% , respectively. However, average fistula rates with these three therapies were 4.7%, 3.4% and 2.5%, respectively. UTI rates varied with the method used and were 17â67%, 0â31% and 4.3â96% for surgery, brachytherapy and cryotherapy, respectively.-

92% 24
  • â Including 14 patients after external beam radiation therapy, five patients after brachytherapy and three patients after proton therapy. Rd., radiation therapy Low, low-risk group Int, intermediate-risk group High, high-risk group NR, not reported.
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  • BOO, bladder outlet obstruction US, urethral stricture.

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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.

How Does Hifu For Prostate Cancer Work

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The MR-guided focused ultrasound is an outpatient treatment that takes about two hours. Patients under anesthesia are placed in an MRI machine that covers the lower half of the body. After the machine takes an image of the prostate, the doctors outline the treatment area and deliver the focused ultrasound waves, guided by the MRI. The ultrasound waves come from different directions, intersecting to attack and kill the cancer by heating the cells to more than 158 °F .

While you are imaging, you are getting temperature feedback as well to make sure the right spots are being treated, Dr. Ehdaie says. The patient wakes up from the anesthesia and goes home. Theres no incisions or wounds on the body to heal. We have demonstrated the procedure is safe for patients, and they can return to normal activity right away.

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Sonablate Hifu For Pc Salvage Therapy

Until the advent of HIFU, when a patient had persistent or recurrent prostate cancer after radical radiation treatment, the only other treatment options were salvage prostatectomy or hormone therapy. It appears that HIFU may provide a noninvasive, safe, and effective salvage treatment in this very-difficult-to-treat population .

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    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.

    Hifu For Prostate Cancer Treatment Cost

    How can HIFU help cure prostate cancer? – Online interview

    The HIFU treatment cost in India is reasonable but depends upon various factors like:

    • Size of the prostate area to be treated: Bigger area and difficult to reach location will need more intensity and more repetitions of shots and thus have more cost.
    • The doctors credentials: The more qualified and better-experienced doctor will be more expensive and have more precision and better results.
    • Location of the hospital: The cost differs for different regions and cities where the hospital is located.
    • Other costs: Medication and anesthesia costs will add to the final cost.
    • If additional therapies are needed: In the case of a large tumor, sometimes laser and Transurethral Resection of the Prostate may be recommended, increasing the cost.

    On average, the best quality HIFU treatment in India ranges from INR 4,50000 to INR 17,00000

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    What Is The Recovery Time For Hifu

    Each person is unique, and each use of HIFU for medical treatment is different. In general, HIFU has a quicker recovery time than other, more invasive forms of treatment.

    Your healthcare team will tell you what to expect and how long itll take you to recover after your HIFU procedure.

    A note from Cleveland Clinic

    High-intensity focused ultrasound has a wide range of applications for medical treatments. Its minimally invasive and usually has a short recovery time. If you have any questions about HIFU or the procedure process, dont be afraid to ask your healthcare provider. Theyre available to help.

    Ablatherm Hifu For Pc Primary Therapy

    The authors identified 11 case series assessing Ablatherm HIFU as a primary therapy option in prostate cancer , which were conducted by four study groups in Germany, France, and the Republic of Korea . Between 58 and 402 patients with localized prostate cancer with a mean age of 6672 years were treated with HIFU. In 4 of 11 case series, patients were recruited consecutively . The mean preoperative PSA level was 712 ng/mL, Gleason score was 7 in most patients, and the mean preoperative prostate volume was 2137 mL. Between 0% and 43% of men received neoadjuvant ADT, and 65100% of patients underwent TURP before or in combination with HIFU. Patients received between one and three HIFU treatments most patients, i.e. 5796%, underwent one treatment. The mean follow-up period varied between 6 and 77 months. The biochemical disease-free survival rate was 66% and 77% after 5 years , and 69% after 7 years . The negative biopsy rate was assessed in all but one study and varied between 65% and 94% the time of biopsy was not specified. In one case series the negative biopsy rate was 86% at 3 months .

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