High Intensity Focused Ultrasound

Why Is Focal Therapy a Good Option?

Whole prostate gland therapy, like surgery or radiation, is an option for the treatment of prostate cancer. Whole gland therapy can damage surrounding structures and may lead to erectile dysfunction and urinary leakage (incontinence.) Many intermediate prostate cancers do not need such aggressive therapy. Focal therapy targets treatment to a specific localized area of the prostate, sparring important tissues, that help preserve urinary and male sexual function. This precision therapy reduces collateral damage by treating only the areas of disease within the prostate sparing normal tissue. HIFU is an attractive option for men with unilateral intermediate-grade prostate cancer due to its cancer control and minimal side effects.

Patients at risk for prostate cancer (^PSA or abnormal exam) will undergo a biopsy to confirm the diagnosis. Prostate MRI and genomic testing have become useful tools to help classify the cancer burden once a prostate cancer diagnosis has been made. Your urologist will interpret these results and make recommendations best suited to your individual needs.

If Focal HIFU Is Right for You

Focal HIFU is delivered via the rectum. Incisions are not necessary to complete this procedure. The ultrasound probe is inserted into the rectum after the onset of general anesthesia. This provides ultrasound images of the prostate and allows delivery of the ultrasound waves. The HIFU device (in our case, FOCAL ONE TM) allows the surgeon to identify and target the desired treatment zone within the prostate. The robotic FOCAL ONE TM system systematically treats the area delineated, while the surgeon monitors the therapy in real-time. Patients are monitored after the procedure and released to go home the same day. A urinary catheter is usually left in the bladder for a few days.

Most patients have mild and expected side effects associated with the treatment, including varying degrees of irritation with urination, urgency and frequency of urination, and blood in the urine. Most of these symptoms improve within the first week after the procedure.

Success of HIFU

HIFU has been performed for many decades. Recent improvements in our understanding of prostate cancer, advances in radiology, and innovations in technology, have improved our treatment outcomes in recent years. In the well-selected candidates, HIFU offers similar cancer survival rates to whole gland therapies, like surgery or radiation, with markedly fewer side effects.¹

FOCAL ONE TM (HIFU Robotic System)

The Focal One Robotic system is the next generation of HIFU delivery. This system leverages today’s most advanced robotic technology, increasing accuracy and precision. In addition, this system offers several safety features including automatic shut-off with patient movement and appropriate vital tissue cooling. These features, among others, make focal HIFU treatment of prostate cancer a safe and effective option.

Limitations

Certain factors may limit the ability to perform focal HIFU. These factors include tumor location and size, overall prostate size, presence of prostate calcifications, and restrictions for access into the rectum.

The Bottom Line

High-intensity, focused ultrasound, or HIFU, is a safe and effective procedure for men who qualify with unilateral intermediate-grade prostate cancer. After the procedure, your urologist will continue to monitor you for signs of cancer recurrence and to ensure urologic health.

Resources:

1. Rischmann P, Coloby P, Chevallier T, et al. HIFU vs radical prostatectomy in the curative treatment of localized prostate cancer GG 1 & 2. Presented at the American Urological Association (AUA) 2024 Annual Meeting; May 3-6, 2024; San Antonio, TX