Jorge Gutiérrez Aceves, M.D.
Urology, Endourology and Robotic Surgery
The High Intensity Focused Ultrasound, or HIFU, is an advanced procedure and technology for the treatment of prostate cancer. It is the less invasive treatment alternative for Prostate Cancer currently available.
Ablatherm ® HIFU system developed in 1989 in France, is currently used in Europe and Canada in 192 large specialized hospitals for the management of prostate cancer, which has demonstrated high effectiveness and safety. Because it is a minimally invasive treatment option, it provides excellent quality of life for patients with localized prostate cancer.
All patients with a diagnosis of localized Prostate Cancer or in initial stages, which require treatment.
1. Focalized Therapy: It is possible to do treatment in only one prostatic lobe in a focalized way if the prostatic biopsies confirm that the diagnosed cancer comes from one lobe in particular. This allows preserving one prostatic lobe intact and completely preserves the patient’s sexual capacity.
2. Tumor recurrence, salvation therapy: In case of previous radiotherapy treatment failure, local therapy with HIFU is possible, reaching similar results to the ones achieved with initial therapy with the same technology.
3. Adjuvant palliative therapy. In case of advanced local prostatic tumor or metastatic prostatic tumor, it is possible to practice HIFU treatment in order to eradicate the growth of local tumorization.
This allows to significantly improve the patient’s quality of life, solving the urinary obstruction symptoms and the obstruction related complications.
More over, recent observations have demonstrated that HIFU treatment as adjuvant or complement to hormonal therapy in locally advanced cancer or metastatic cancer, favors the response to hormonal treatment in the long run with the possibility to extend the patients life.
The procedure is done in a surgery room, under regional anesthesia and anesthetic sedation. The treatment takes from 2 to 3 hours depending on the prostate size, and after treatment only 24 hours of internment are required. The patient is placed on his right side and a transducer is placed through the rectum, which is controlled in a robotic form. This transducer manages the high frequency waves, which at the same time are controlled by the doctor through computer images.
After treatment, due to inflammation in the prostate, the placement of a transurethral catheter for 1 to 2 weeks long is necessary. Some patients are candidates for a transurethral prostate resection prior to treatment at the same surgery room, which reduces the time of having the transurethral catheter for 1 to 2 days long.
Pain after treatment is rare, usually the patient feels a mild prostatic discomfort that disappears in a few days. Being a minimal invasive procedure, there are no incisions or skin wounds and no discomfort or burning sensation, associated with radiotherapy, is experimented while urinating.
Several European studies have shown the absence of cancer cells by up to 92.1% of the cases of prostate biopsy after the procedure. Also during the clinical follow up of patients over five years, up to 86% of them showed levels of prostate specific antigen at optimal levels (<0.1 ng / ml) in a stable manner.
In most cases, patients will not require any other therapy for the management of prostate cancer. In case of requiring it, a second HIFU session can be done in a secure form, or another available therapy for Prostate Cancer.
Complications and side effects
As in all other treatments for prostate cancer, there are some minor side effects and complications related to the implementation of the high frequency ultrasound waves. The frequency of the side effects and serious complications is very low. With the use of HIFU robotic technology, the complication rate is decreasing due to the high possibility of targeting treatment in affected areas. The probability and severity of side effects and complications may vary in each patient, so the physician should advise properly and individually to each.
1.Summary and update of information
5. Combination with other therapies