“Dr. ‘Bones’ McCoy, the character in the Star Trek television series, dreamed of the concept of practicing surgery without a scalpel. With the advances in HIFU for prostate cancer, that dream is now a reality. HIFU with the Sonablate 500 provides real-time visualization of the anatomy, treatment guidance, and thermal feedback with its Tissue Change Monitoring.”
George M. Suarez, M.D.
Founder, Medical Director Emeritus
USHIFU, International HIFU
Dr. Suarez from Hifu Prostate Cancer Institute Miami, like Dr. McCoy, was ahead of his time when he envisioned and pioneered HIFU as a prostate cancer treatment—and made it available to the Americas.
Patients marvel at HIFU and how it works. How is it possible, they ask, that such high energy (2000 watts/cubic cm) can be converted to a lethal temperature (100 degrees Celsius) and destroy cancer deep in the body, yet not cause any injury to intervening or surrounding tissue?
Dr. Suarez often refers to HIFU as an acoustical scalpel with the ability to accomplish all the objectives of a standard scalpel by utilizing ultrasound energy but without any cutting. It treats distinct targeted tissue with pinpoint accuracy, and without scatter of energy or damage outside the targeted focal point of treatment. It is the most Minimally Invasive Surgical Treatment (MIST). He is often asked if it is a surgical procedure at all, or simply a therapeutic treatment. It is a tissue sparing therapy that does not harm adjacent healthy organs. It is focused on treating the regions of cancer with successful cancer control, but without compromise to quality of life functional outcomes.
Is HIFU the right treatment for you?
HIFU is one of several treatments for prostate cancer that is still contained in the prostate gland. This is called “localized cancer” because it has not yet spread outside of the prostate capsule where it can travel to other parts of the body. When it is still contained, it is considered potentially curable.
There is no “one size fits all” treatment. All prostate cancer treatments have some degree of risk. Some are more invasive than others. The goal of treatment is to eliminate the cancer with little to no impact on urinary, sexual and bowel function. Thus, many factors go into making a treatment decision. These include a patient’s age and overall health; the stage of his cancer; the aggressiveness of his cancer; his current quality of life, including sexual activity, and his expected quality of life after treatment.
HIFU is an excellent choice for patients with localized disease who do not want surgery or radiation, who want good results with destroying cancer, and who want minimal risk of urinary, sexual and bowel side effects. It’s an excellent choice for patients who want a quick return to their normal activity level.
Remember that you and your doctor become a decision-making unit, so we encourage you to choose a prostate cancer specialist who will help you understand your prostate cancer and weigh the merits of each treatment, including HIFU.
If HIFU is on your list of considerations, we hope that everything you learn here will help you determine if HIFU is an excellent choice for you.
HIFU OR ACTIVE SURVEILLANCE (AS)?
Over the years, the percentage of patients diagnosed with low-risk disease has increased due to increased active screening. Many cancers are thus over detected, over treated & subjected to unnecessary harms and costs.
On the other hand, 30% to 40% of men undergoing standard treatment options such as radical prostatectomy (RP), radiation therapy or cryosurgery for presumed low risk disease have either had higher grade, higher stage or both on pathologic staging after treatment. In other words, they were under treated. So our current tools are simply not good enough to accurately assess risk. Given the lack of confidence in risk stratification it is understandable that a majority of men today receive immediate therapy. However, there is a subset of patients who appear to have early stage, low risk cancer. They are aware that whole gland treatment might turn out to be overtreatment with damaging side effects, so they wish to defer treatment. These patients, with their doctors’ blessing, often choose Active Surveillance.
Active Surveillance means putting off treatment while embracing healthy nutrition, exercise, stress management, supplements, and calming meditation or breathwork. AS is not for everyone. Many men can’t psychologically tolerate the thought of cancer in their bodies, and eventually seek treatment. Other AS patients have good intentions, but backslide on their health program. When their PSA rises, they too seek treatment.
There is a middle ground between over treatment and Active Surveillance. HIFU offers a proactive treatment options with reduced risk of side effects while offering excellent cancer control. Thus, it resolves the dilemma between delaying treatment, which risks cancer growth, and a whole gland treatment, which risks impaired quality of life.
The criteria for HIFU, a minimally invasive ablative therapy, are similar to Active Surveillance Involves:
- Careful selection of men at low to moderate risk of harm from prostate cancer without treatment.
- Careful monitoring of those who select active surveillance includes a digital rectal exam and PSA every six months with a prostate biopsy every 12 months, a rigorous protocol. In fact the majority of men eventually opt for treatment based on either progression of the disease or anxiety over the unpredictably of their cancer.
- Careful monitoring of those who select HIFU is limited to a PSA every three months after treatment and every six months thereafter. The only indication for a post-HIFU biopsy is 3 progressive elevations of the PSA.
- Men on AS whose cancer is beginning to progress may be advised to seek a curative treatment. These men are excellent candidates for HIFU.
- There have been a number of publications looking at active surveillance (AS) outcomes across a variety of cohorts. Although each of these cohorts enrolled or selected men with favorable risk profiles there were differences in patient selection as well as differences in surveillance protocols and triggers for intervention. Despite these differences, AS is demonstrated to be exceedingly safe. With median follow ups of around 40 months (just barely at the 4 year mark) the prostate cancer specific survival in a group of over 3,700 men was above 99%. Whereas, the risk of a secondary HIFU over a 10-year post treatment is a mere 2%.
Selection of Candidates for HIFU or Active Surveillance includes
- Tumor clinical and pathologic features
- Metrics –risk stratification, markers/assays
- Patient factors
- Life expectancy, age, and overall health
- Patient preferences
Some Diagnostic and treatment Challenges remain
- Appropriate diagnosis
- Active surveillance of indolent tumors
- How aggressively to treat the intermediate/high risk groups
ARE HIFU PATIENTS HAPPY WITH THEIR CHOICE?
Read the International HIFU Patient Survey Booklet to find out how satisfied patients are.
Why Choose Hifu Prostate Cancer Institute Miami?
PERSONALIZED CONCIERGE Medical Care, 24 Hours / 7 Days Per Week:
Most medical treatments, including HIFU, are performed in brief time frame. In fact, diagnosis, arriving at a treatment decision and post-treatment care consumes the majority of patient-doctor time and care. By offering PERSONALIZED- CONCIERGE medical care, our patients have 24/7 access to Dr. Suarez.