By: Dan Sperling, MD
Prostate cancer patients seeking an alternative to surgery or radiation are attracted to treatments that are minimally invasive (less pain, rapid recovery), repeatable if necessary, and able to be done focally (fewer side effects). Of course, not everyone will qualify for a focal treatment, but patients who require a whole-gland treatment still seek minimally invasive ablation, with its repeatability.
HIFU, or High Intensity Focused Ultrasound, is one such treatment. It uses focused sound waves to generate extreme heat. It is delivered to the prostate by means of a transrectal probe, and is usually done under ultrasound image guidance. It can be done as a whole gland treatment, or a more tailored approach, and it claims to have less risk of urinary and sexual side effects. It is not yet approved by the U.S. Food and Drug Administration, so patients must travel outside the U.S. for this treatment.
A new article in the Journal of Urology got my attention.[i] It reports data on 359 patients (from 2004-12) who underwent whole-gland HIFU as a first treatment for localized prostate cancer. 36.2% eventually needed a second HIFU. The numbers were drawn from a United Kingdom registry, or database. I was struck by some of the numbers the authors reported.
Patients were re-treated with HIFU becuase there was evidence that the first HIFU had not successfully controlled the cancer (based on rising PSA, MRI evidence of localized residual disease, or actual biopsy). In other words, whole-gland HIFU in this series of patients had a failure rate of over 35%. The authors compared the incidence of urinary and sexual side effects between the primary HIFU and the repeat HIFU. Here are the numbers that stood out for me:
- Before the second HIFU, 73.3% had no urinary leakage; it dropped to 55.1% after the second.
- Before the second HIFU, 2.7% were using daily pads; afterward it rose to 9%.
Based on their analysis, the authors concluded that repeat HIFU is associated with higher rates of urinary side effects than primary HIFU, though sexual side effects were about the same in both cases.
All of us who offer treatment for localized prostate cancer continually strive to improve on all levels. It is important to report results for all therapies. In this way, we learn from each other; device manufacturers improve their technology; patients have an informed knowledge before they make a choice. I respect the authors of this article for publishing this information, and offer it to my readers to take into consideration if they are considering HIFU as a treatment option.
[i] Berge V, Dickinson L, McCartan N, Hindley R et al. Morbidity Associated with Primary High Intensity Focused Ultrasound and Redo High Intensity Focused Ultrasound for Localized Prostate Cancer. J Urol. 2014 Jun;191(6):1764-9.