What are you going to do if you have had radiation therapy as a primary prostate cancer therapy and the cancer has reoccurred? If the disease has remained in the prostate gland some men are able to go back and have surgery, but the condition the gland has been left in post radiation makes it very difficult to perform the surgery. At this time most doctors recommend that you move on to hormone therapy (ADT), which provides no hope for a curative result.

There has been a recent interest, as well as some clinical trials, using high intensity focused ultrasound (HIFU) to see if it can offer a cure to men at this stage. HIFU has already been approved for use in Europe, Canada, Mexico, India and South America as a treatment after failed radiation therapy. HIFU is in the final stages of obtaining FDA approval in the United States.

HIFU is described as a minimally invasive, outpatient prostate cancer treatment. The technology destroys tissue using extreme heat generated by focusing ultrasound waves (not radiation) on a specific target site. The ultrasound energy is delivered in rapid-fire succession to targeted tissue, in this case throughout the remaining prostate gland. The tissue at each target is destroyed while surrounding tissue remains unharmed. HIFU does not use radiation and is not a surgical procedure.

“We hope that HIFU will make patients with recurrent prostate cancer disease free, without the side effects of hormone therapy or other treatments,” says Laurence Belkoff, DO, urologist with Urologic Consultants of Southeastern Pennsylvania, an institution that has been participating in one of the current clinical trials investigating HIFU in men with recurrent prostate cancer.

To qualify for these trials, men must be experiencing a rising PSA after having been previously treated for prostate cancer with external beam radiation therapy. A biopsy and other tests must show that the cancer has returned, but has not spread beyond the prostate.

Currently, there are two separate trials active and recruiting men to evaluate HIFU as a treatment protocol for recurrent prostate cancer:

A Multicenter Clinical Study of the Sonablate®500 for the Treatment of Locally Recurrent Prostate Cancer With HIFU (STAR) -NCT00772317

Prostate Cancer Treatment Following Radiation Failure With High Intensity Focused Ultrasound (HIFU) – NCT00318240

Information about these trials may be found at www.clinicaltrials.gov

HIFU might offer a last effort to cure prostate cancer after radiation failure. I believe that it offers great promise and encourage anyone who is experiencing failed radiation therapy to give serius consideration to entering one of the trials. Cure is much better than palliative measures, you can still move to hormone therapy if the HIFU also fails.

Joel T Nowak, MA, MSW