Basics on HIFU for Prostate Cancer- is it the right treatment for you?

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Basics on HIFU for prostate cancer

I am always looking into prostate cancer treatments that offer a balance of cancer control, minimal risk of  urinary and sexual side effects, and the ability to integrate whole-health practices to help prevent cancer from coming back. At this year’s American Urological Association (AUA) meeting in San Diego,  I learned a little more about HIFU.

What is HIFU?

HIFU stands for High Intensity Focused Ultrasound. Ultrasound is sound waves that the human ear can’t hear, and pass harmlessly through tissue.  It has most commonly been used to capture images within the body (not to different than those black-and-white images of a fetus inside the mother’s uterus). If those same sound waves are emitted at a different wavelength, and focused down to a very small point, they create lethal heat precisely at that point. The target tissue is destroyed, yet HIFU passes harmlessly through any other tissue between the source and the target. Think of it like this: imagine you take a magnifying glass outside on a sunny day. You hold the magnifying glass so that the sunlight forms a small, bright point on the sidewalk. That small area will quickly become very hot, but the air in between the lens and the sidewalk doesn’t feel any hotter.

A little HIFU history

HIFU has been around for decades. In the U.S., research began in the 1950s at Indiana University. In 1994, the first human prostate cancer study was done at the University of Vienna. Two doctors treated 29 human prostates shortly before performing a radical prostatectomy. Their goal was to see if the energy delivered truly destroyed the prostate tissue, which it did. Further studies established that HIFU could be performed safely and could be repeated. In 1995, a study done at Indiana University showed that the whole prostate could be treated without damaging the prostate capsule or the rectal wall.

HIFU for prostate cancer does not involve any surgery, so it’s non-invasive. Sound waves can be precisely controlled, so unlike radiation there’s no scatter effect. Thanks to the high heat, the treatment is immediately effective, and the destruction can be confirmed. While the patient is under anesthesia, a catheter is inserted that will remain in place for several days to two weeks to empty the bladder while the prostatic urethra (the part of the urinary passage that passes through the prostate) is healing. When patients recover from the anesthesia, they literally walk away from the procedure. Many feel so good that they literally wonder if the doctor did anything at all besides place a catheter!

As you know from reading my blog, I like effective treatments that include a quick return to normal activity. HIFU has some additional advantages.

1.     Thanks to the imaging ultrasound and software that is built into the HIFU device, a patient’s prostate gland can be measured and mapped so that the neurovascular bundles that control sexual function are not damaged during the procedure (provided the cancer has not invaded those bundles).

2.     Because of the ability to target HIFU into a structure as small as a grain of rice, HIFU can be done as a focal treatment. In other words, only the cancerous area, plus a margin of safety, would be destroyed. This preserves the healthy prostate tissue, and virtually assures urinary and sexual performance after treatment.

3.     A patient with early stage, low-risk prostate cancer who is qualified for a focal treatment (including many patients currently on Active Surveillance) can safely undergo HIFU without losing any future treatment options. After a focal HIFU, if cancer came back, the patient could consider a repeat HIFU, surgical removal (prostatectomy), radiation or cryotherapy (freezing).

4.     And from the viewpoint of my personal practice emphasizing nutrition, supplements, acupuncture and lifestyle improvements such as exercise and meditation, patients who have a focal HIFU treatment can implement a whole-health approach to help prevent prostate cancer—or any other cancer—from developing.

HIFU is not yet FDA-approved in the U.S., even though it has been used for more than a decade in Europe, Latin America, China, Japan, and Canada. However, the two HIFU manufacturers are in the process of applying for FDA approval, and I am optimistic that HIFU will soon be available here. I join in spirit with all the patients who are counting the days until HIFU joins the U.S. list.

Lastly, not everyone with prostate cancer is a candidate for HIFU. One should see a HIFU expert (links below) to determine if HIFU is the right treatment for a newly diagnosed prostate cancer patient.

For more information:

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by Dr. Geo

2 comments… add one
  • Ron Williams 05/29/2013, 10:32 AM

    Dr. Geo,

    I have gone through HIFU twice within the past year and a half. Prior to the treatment, my HIFU Physician requested a “3-D” MRI at a particular imaging facility in NY. When filling out the paperwork to undergo the MRI, the form wanted to know if I had any type of implants. I wrote down that I underwent Tube-Shunt Implant Surgery of the right eye in 2010. This device is non-metal, and constructed basically of a soft plastic hose to allow aqueous drainage from glaucoma. Unfortunately, they were unsure of possible harm to my eye (although my head was outside) as they would not let me undergo the 3-D MRI, and elected to performed another type that did not give 3-D images. When my HIFU physician examined the MRI, he saw that there was a small tumor on the right side, but was unclear about the left side, and suspected that there was nothing there. He really wanted me to have the 3-D MRI. The first HIFU treatment was focal treatment on the entire right half side of my prostate (November 2011). Prior to the treatment, my PSA slowly climbed from 4.0 to 4.2 (Gleason Score 3+3=6). Three months after the first procedure, my PSA reading dropped to 3.0, and within seven months, the level gradually climbed to 4.1. My HIFU Physician suggested that I visit him to have another biopsy, and this time I had a 3-D MRI. In examining the 3-D Image, my HIFU physician pointed out a small tumor on my left side, in which the first (non 3-D) MRI did not show. The right side showed NO signs of tumor/cancer which was treated. That same day, my doctor gave me a biopsy which showed the treated right side had no cancer, however the left side showed a small amount. In August 2011, I went through a second treatment of HIFU to treat the left side. Three months later my PSA was recorded at 2.6. Three months following that, my PSA climber to 3.0. Three months after that it went to 3.5. In April 2013, I visited my HIFU physician again for a 3-D MRI and Biopsy. MRI images did not show anything on either side, but the biopsy showed a small amount of cancer on the right side (which was treated in 2011, and biopsy was negative then). My doctor sail that he has never given a patient a third treatment, and suggested that I see a Radiologist in hope of treating the small amount of cancer on the right side. He also said that if I am not comfortable about radiation treatment, he would be willing to give me a third treatment.

    Dr. Geo, I am fairly young (57) and can obtain an erection without medication. The reason that I elected HIFU is because the risk of impotence is less chance the other procedures, however HIFU is very expensive. I also wanted to weigh all of my options. I didn’t want to go directly to surgery (as my local Urologist was pushing for). Therefore I am considering Radiology. Then if this doesn’t work, I will consider surgery. How do you feel about decisions?

    • Dr. Geo 05/29/2013, 11:21 AM

      Hi Ron, your story underscores the fact that there are no perfect treatments for prostate cancer. Before I provide my opinion please know that this is my opinion and since you are not my patient and I do not know other details for your health, my opinion may not be too valid. However, since there are many readers who are going to read this, here’s some general information that may be helpful:

      1. With the description you provided, I am not sure you need any treatment at all at this time. It seems like you have a low-risk situation that can be left alone or at handled with intensive lifestyle medicine – what I call CaPLESS approach (stay tuned, more to come soon on this). I am not sure more aggressive treatment is necessary.

      2. Along with a CaPLESS approach (exercise, plant-based / mediterrenean diet) you may be interested in specific supplements that may be helpful. – Tier one on the home page. This is a group of supplements excellent for your situation.

      3. It may be worth for a nutritionally oriented physician to be part of your team to customize your lifestyle program.

      I hope this helps Ron.


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