High-Intensity Focused Ultrasound (HIFU) is slowly becoming a better-known treatment for prostate cancer in the United States. (What is HIFU- high-intensity focused ultrasound that rapidly heats and destroys the prostate.) HIFU has been used in Europe and Mexico for a period with an increasing number of Americans becoming interested in it and traveling to receive the treatment. Recently there have been a few sites in the United States offering HIFU as a primary treatment in the U.S. as a part of a FDA approved phase III clinical trial.
HIFU, as a salvage treatment for recurrent prostate cancer, has not been greatly studied. More commonly, therapeutic options used for recurrent disease includes salvage prostatectomy, salvage cryotherapy, hormonal therapy or watchful waiting.
Drs. Chalasani V, Martinez CH, Lim D, Chin J. of the Department of Urology at the University of Western Ontario, London, Ontario, Canada recently wrote a review of the literature about the use of salvage HIFU when prostate cancer recurs. They found that there have not been any randomized or prospective studies on this subject. Efficacy results of 17-57% have been reported from retrospective case series, with reported toxicity including rectal fistula in 0-16%, and incontinence in 10-50%.
Salvage HIFU appears most appropriate for those patients with histologically proven local recurrence only, with a life expectancy of at least 5 years and with some medical comorbidity rendering them not ideal for salvage prostatectomy.
Prostate Cancer Prostatic Dis. 2008 Oct 14. Epub ahead of print.
Joel T Nowak, MA, MSW