The Physics of HIFU and the Importance of 3 Dimensional (3D) Image Guidance in Real Time
HIFU, or High Intensity Focused Ultrasound, uses focused sound waves to generate sufficient heat to destroy tissue. The sound waves are precisely aimed at the location, size and shape of the tissue to be destroyed. This is called ABLATION, or destruction. The sound waves are delivered in separate systematic and overlapping shots calculated to leave no living tissue behind.
An important feature of sound waves is that they pass harmlessly through body structures on their way to the target. It is only where they converge at the target that the heat occurs. Unlike radiation, there is NO SCATTER EFFECT. It’s important to know that radiation therapy for prostate cancer has entirely different physics than HIFU. HIFU immediately destroys tissue because it generates heat. Radiation does not generate heat. Rather, it interferes with the cell’s DNA so that the call cannot reproduce itself. Four important differences:
- Radiation exposure must occur over time. It is not immediately effective. Thus, beam radiation requires several weeks of treatment, and radioactive seeds (brachytherapy) are designed to be left in place in the patient’s body in order to keep exposure on the cancer. HIFU, on the other hand, requires only a single outpatient treatment to destroy cancer by extreme heat.
- Radiation always has some scatter, which puts healthy tissue at risk over the long term. Although there may be minimal to no side effects immediately after radiation, they may develop during the following years. This includes urinary, sexual and bowel side effects. There is also an increased risk of developing future cancer in nearby structures, such as the rectum or bladder, due to radiation exposure. HIFU does not create future side effects in the years after treatment.
- Radiation cannot be repeated in the same area. If cancer comes back, another treatment method would be necessary. HIFU is repeatable if necessary.
- Radiation causes gradual cell death, which cannot be seen or monitored by imaging. In fact, PSA is the only way to monitor whether radiation has been effective, and it can be up to 18 months before a patient’s PSA value reaches “nadir”, meaning its lowest value after radiation. HIFU is monitored in real time during the procedure by registering tissue changes as ablation occurs. Within 1-3 months, a patient’s PSA reflects a successful treatment.
Hifu treatment is guided by ultrasound imaging. This allows a doctor to see and measure the prostate gland before treatment, so the correct regions to be ablated can be correctly calculated. It also allows the doctor to avoid treating healthy tissue and nearby delicate structures. Thus, HIFU can be “shaped” to spare potency for qualified patients, because the neurovascular bundles are safely preserved from the ablation power of HIFU.
HIFU can be tailored to ablate (destroy) as much or little of the prostate gland as careful diagnosis, physician advice, and patient agreement indicate.
The technology used by Dr. Suarez, called the Sonablate 500, includes built-in ultrasound that operates in real time during the HIFU procedure. The Sonablate 500 also has special technology to monitor tissue changes as they occur during the ablation process. Thus, Dr. Suarez can be sure that his treatment is effectively destroying the patient’s cancer.
A robotically controlled “stepper” regulates the movement of the HIFU probe, a patented device invented years ago. This instrument affords adjustments as small as a millimeter, adding to the accurate and precise treatment. The movements of the stepper are guided by sophisticated computer planning based on conceptual 3-dimensional images of each patient’s unique prostate gland and disease, whether it be a whole gland treatment, or a partial (focal) treatment.
The illustrations below are based on the conceptual 3D images that guide treatment.
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