What is HIFU?
High Intensity Focused Ultrasound, or HIFU, is an emerging therapy that destroys tissue with rapid heat that is focused on the malignancy in the prostate gland. (HIFU can also be used to treat BPH.)
HIFU is useful only when treating a single tumor or part of a larger tumor; it cannot treat prostate cancer that has spread. The procedure involves focusing sound waves on the prostate tumor, which heats the cancerous area and destroys tissues in the prostate. Tissue is destroyed without any damage to overlying or adjacent structures.
The entire procedure can take from one to three hours, and you need to have a urinary catheter in place for about two weeks following the procedure.
Where Can I Get Treated with HIFU?
HIFU has been used around the world to treat prostate cancer, although it has not yet been approved by the FDA in the United States. However, HIFU using the Sonablate® 500 device is currently undergoing Phase III clinical trials in the United States and Canada, with final data collection expected to be completed by the end of 2010 and, if all goes well, application for FDA approval in 2011. In a previous small US safety trial, 91 percent of the participants had a negative biopsy six months after receiving HIFU treatment. HIFU is currently available to patients in locations close to the USA such as Bermuda and Mexico.
Is HIFU Safe?
Elsewhere around the world, HIFU has been studied more extensively. A major problem with the majority of the studies, however, is that they have been uncontrolled. In a recent (September 2010) study published in European Urology, an investigative team conducted a systemic review of studies of HIFU from 2000 to 2010 that had included more than 50 participants. They evaluated 20 uncontrolled prospective studies with a total of 3,018 patients and discovered that the overall survival rates were 90 percent at 5 years and 83 percent at 8 years. Because the studies did not use control groups, the investigators reported that the available evidence on the effectiveness and safety of HIFU in men with prostate cancer requires more research. More on side effects of HIFU
HIFU and ED
Because HIFU (high intensity focused ultrasound) is still a relatively new therapy, there are few studies of the impact of HIFU on erectile function and other side effects it may cause. A new study published in the May 2010 issue of Journal of Sexual Medicine offers some insight. Investigators found that 36 months after undergoing HIFU, 65.5 percent of men had regained erectile function. They also reported no significant change in penis size at 36 months when compared with before HIFU. (Li) Over a mean of 41 months, 20 percent of men in another study had urinary incontinence associated with HIFU and an erectile dysfunction rate of 77 percent. (Ripert) A review of the impact of HIFU on erectile dysfunction in another recent study found that it may occur in the range of 20 to 49.8 percent of men. (Mearini).
Focal therapy (HIFU) for localised unifocal and multifocal prostate cancer-Ahmed-2012
References
Li LY et al. Comparison of penile size and erectile function after high-intensity focused ultrasound and targeted cryoablation for localized prostate cancer: a prospective pilot study. J Sex Med 2010 Sep; 7(9): 3135-42
Mearini L, Porena M. Transrectal high-intensity focused ultrasound for the treatment of prostate cancer: past, present, and future. Indian J Urol 2010 Jan-Mar; 26(1): 4-11
Warmuth M et al. Systematic review of the efficacy and safety of high-intensity focused ultrasound for the primary and salvage treatment of prostate cancer. Eur Urol 2010 Sept 17
Blana A et al. Eight years experience with high intensity focused ultrasonography for treatment of localized prostate cancer. Urology 2008; 72:1329-33
Chaussy C, Thuroff S. The status of high-intensity focused ultrasound in the treatment of localized prostate cancer and the impact of a combined resection. Curr Urol Rep 2003; 4:248-52
Li LY et al. Comparison of penile size and erectile function after high-intensity focused ultrasound and targeted cryoablation for localized prostate cancer: a prospective pilot study. J Sex Med 2010 Sep; 7(9): 3135-42
Mearini L, Porena M. Transrectal high-intensity focused ultrasound for the treatment of prostate cancer: past, present, and future. Indian J Urol 2010 Jan-Mar; 26(1): 4-11
Ripert T et al. Transrectal high-intensity focused ultrasound (HIFU) treatment of localized prostate cancer: review of technical incidents and morbidity after 5 years of use. Prostate Cancer Prostatic Dis 2010 Jun; 13(2): 132-37
