After more than 10 years of clinical trials, the Food and Drug Administration last fall approved the use of High Intensity Focused Ultrasound (HIFU) to treat prostate cancer. HIFU is a minimally-invasive, radiation-free procedure that has been used in Europe, Asia, and much of the rest of the world for over 20 years.
Drs. Sarat Sabharwal and Dr. Daniel Cohen of Same Day SurgiCenter of Orlando became the first in Central Florida, to begin performing the outpatient procedure that can zero in on cancer cells while protecting surrounding tissue and minimizing chances for erectile and urinary dysfunction associated with other treatments.
Stan Sujka, MD, a urologist with Same Day SurgiCenter, first observed HIFU treatments in the Bahamas several years ago to learn more about the technology and came away impressed with the procedure and the results.
"This gives us another tool to use in terms of fighting significant prostate cancer," he said. "The results of the procedure have been comparable to any other of the modalities used to treat prostate cancer."
Traditionally prostate cancer was removed surgically in the United States but it also comes with a high risk of incontinence and erectile dysfunction, noted Dr. Sabharwal who has performed over 70 of the procedures.
"It has improved but not completely," he said. "The other option for patients is to undergo radiation therapy which has its own side effects. It can cause concern for future cancers in surrounding tissues."
How HIFU Works
An ultrasound probe is inserted into the patient's rectum under general anesthesia during the HIFU procedure. HIFU waves are concentrated from the transducer (similar to a magnifying glass) into the ablation zone. The surgeon directs this focused ultrasound energy precisely to the cancerous areas of the prostate to ablate the targeted cancerous tissue and a rim of normal tissue, minimizing damage to surrounding tissue.
"Once the tissue has been desiccated, heated and is dead, the body will reabsorb the tissue, and that essentially is the end of the tumor or the lesion," explained Sabharwal. "It's a treatment that minimizes the side effects and enables the patient to return to their normal activity and preserve the quality of life after treatment. It also allows us to do focal treatment and just treat the cancerous areas and preserve the surrounding tissues."
Upon completion, the surgeon can analyze the results in real time using ultrasound imaging and monitoring software that tracks changes in the tissue. When the surgeon is satisfied with the ablation, he or she can remove the probe and the patient is transferred to recovery. The entire procedure takes about two to three hours.
Urologist Jack Cassel, MD, affiliated with Florida Hospital Waterman, has performed over 50 HIFU procedures at both Same Day SurgiCenter of Orlando and Florida Surgery Center. He cited these primary benefits of using HIFU:
• No surgery
• No hospitalization
• No direct side-effects
• No incontinence
• No impotence
"HIFU is an ideal treatment for prostate cancer," he said. "It's the least traumatic way for patients with Stage 1 or Stage 2 prostate cancer to get cured. I do prefer to treat people with small prostates and low volume cancer. But there are no downsides to it. Invariably these people are cured and everything goes great."
Although it is designed as a one-time treatment, another advantage, according to Sujka, is that if a physician does not ablate the entire prostate, they can repeat the procedure until they do. It does not preclude any future therapy such as surgery or radiation.
"You don't burn a bridge for radiation therapy," he said. "If a patient has radiation treatment for prostate cancer, and there is a recurrence, that patient usually cannot have surgery because radiated tissue does not heal very well. By having HIFU first, you can still undergo radiation treatment or surgery to remove the prostate if necessary."
Cassell added that the field of urology has been the recipient of many advanced minimally invasive procedures over the last couple decades.
"This is just another minimally invasive procedure which is easy for a doctor to perform and for patients to go through," he said. "This is clearly the most effective, least invasive prostate treatment available. Every urologist in the country should know that this technology exists and see how easy it is to perform."