HIFU or High Intensity Focused Ultrasound is a focal treatment for prostate cancer that allows precise application of heat to destroy cancer tissue. A probe is placed in the rectum for treatment, and high-energy ultrasound waves are focused on the prostate, which is 1-4centimers away. Importantly, the intervening tissue including the rectum is not heated. The treatment is radiation free and does not require incisions.
Aggressive or large prostate cancers are best treated with surgical removal or radiation, but smaller or less aggressive cancers are good candidates for treatment with HIFU. Some advantages of focal HIFU treatment include lower rates of urinary leakage (incontinence), better erectile function outcomes, and the ability to go home the same day. A urinary catheter may still be needed for a couple days, but this is less than the week typically required by surgical removal of the prostate.
While the device was approved in 2015 in the USA, the technology was pioneered at Indiana University in the 1970s with the first HIFU device for treatment of prostate cancer being built in Indianapolis in 1996. On April 26, 2000 a cancer symposium was held at Indiana University School of Medicine where the first research protocol was crafted for HIFU prostate treatment in the United States. Participants included current Indiana University Urologists Michael Koch and Thomas Gardner as well as researchers from the University Hospital Cleveland, Wake Forrest University, University of Bern, University of Vienna, and University of Amsterdam among others.
In 2007, Dr. Michael Koch and others published on the first 20 patients treated with HIFU in the United States.1 They reported few side effects and that HIFU had potential for treatment of early stage prostate cancer. They found that ablation of the whole gland can cause temporary swelling and the need for a temporary urinary catheter. This increased the interest in focal or partial gland ablation. Subsequent studies on HIFU partial gland treatment have demonstrated preservation of erections in close to 90% and a 100% pad-free rate by 3months. 2,3
Indiana University was one of the first centers in the United States to purchase a device after FDA approval, and is currently treating patients. Early results from patients treated with HIFU at Indiana University show few side effects and promising cancer control. All patients have been able to go home the day of surgery without a supra-pubic catheter. For more information see Indiana University HIFU.
Clint Bahler, MD, MS
Assistant professor of Urology, Indiana University School of Medicine
The first HIFU research protocol was developed at Indiana University with current department of Urology faculty Michael Koch and Thomas Gardner contributing.
References:
- Koch MO, Gardner T, Cheng L, et al: Phase I/II Trial of High Intensity Focused Ultrasound for the Treatment of Previously Untreated Localized Prostate Cancer. J. Urol. 2007; 178: 2366–2371.
- Yap T, Ahmed HU, Hindley RG, et al: The Effects of Focal Therapy for Prostate Cancer on Sexual Function: A Combined Analysis of Three Prospective Trials. European Urology 2016; 69: 844–851.
- Ahmed HU, Hindley RG, Dickinson L, et al: Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. Lancet Oncol. 2012; 13: 622–632.
