What’s New in HIFU?
Advances in Ultrasound Technology Offer New Options
to U.S. Prostate Cancer Patients
By Brian J. Miles, MD
Houston Methodist Urology Associates
Professor of Urology, Institute for Academic Medicine
Houston Methodist – Weill Cornell Medical College
After delivering a diagnosis of prostate cancer, doctors typically inform their patients about three basic approaches to managing the disease: active surveillance (“watchful waiting”), radiation therapy, or radical surgery to remove the entire prostate.
Increasingly, however, patients in the U.S. have access to a different option: High Intensity Focused Ultrasound (HIFU).
The use of HIFU in this country has been on the upswing since 2015 when the FDA approved it for “prostate tissue ablation,” meaning the technology can be employed to remove or destroy prostate tissue.
Today, urologists at major medical centers, ranging from Houston Methodist Hospital to the University of Chicago, University of Miami and Duke University are using HIFU with patients who have localized prostate cancer (the type that has spread in but not beyond the capsule of the prostate gland.) And HIFU was validated by the Centers for Medicare and Medicaid Services (CMS) in mid-2017, when the agency created a specific billing code for partial reimbursement for Medicare patients who choose the HIFU option.
HIFU is a minimally invasive, radiation-free procedure that directs high-frequency sound waves to destroy the diseased area of the prostate, while sparing other parts of the gland and potentially reducing the risk of side effects like impotence or incontinence.
In Europe and around the world, HIFU has been used to treat more than 45,000 patients with encouraging results in terms of both survival rates and quality of life. For instance, a multicenter study conducted by the French Association of Urology (AFU) showed optimal preservation of continence for 97 percent of patients and erectile function for more than 78 percent of men.
Fusing HIFU with MRIs and Biopsy Data
Advances in the technology are opening up new possibilities for urologists and their patients. One of the most significant advances is “fusion HIFU.” Like other types of ultrasound technology — such as that used to examine fetal development during a pregnancy — HIFU employs a probe to illuminate the inner workings of the body. With HIFU, doctors not only view those internal images in real-time but also guide the probe in heating up and burning off a targeted area within the prostate.
The newest generation of HIFU can now fuse those ultrasound images with those imported from MRIs and/or 3D biopsy findings. Doctors can then view the integrated 3D images on a monitor. That fusion enables surgeons to focus the ultrasound waves with precision to ablate the specific area of cancerous tissue shown in the MRI or biopsy images.
Because this new fusion capability allows for better targeting of the diseased tissue during treatment planning, the margins around the contours of that tissue can also be smaller than the margins that might have to be removed with less precise procedures. To a certain extent, this precision helps doctors avoid damaging healthy tissue which is one reason prostate cancer patients undergoing HIFU procedures can experience fewer side effects.
While HIFU may not be appropriate for all patients diagnosed with localized prostate cancer, it is a viable option for those who find active surveillance stressful as well as those seeking to avoid whole gland ablation. It bridges the gap, creating a middle ground between those two approaches to the disease and it allows patients to maintain their quality of life.