Vanderbilt urologic surgeons are offering an alternative therapy for prostate cancer patients considered to be low-to-intermediate risk, a middle ground between active surveillance and aggressive therapy.
High-intensity focused ultrasound (HIFU), approved by the FDA in 2015 as a surgical tool for the destruction of prostate tissue, is intended to reduce potential side effects that come with aggressive therapy while still treating the cancer.
“We know that, historically, we’ve overtreated patients with prostate cancer,” said Kristen Scarpato, MD, assistant professor of Urology.
“We now appropriately enroll more patients for active surveillance. However, some patients who are not ideal candidates for surveillance may benefit from HIFU. Others may actually be harboring clinically significant disease that has not yet been diagnosed.”
Scarpato said patients with low-to-intermediate risk (Gleason 3+4) prostate cancer are candidates for HIFU, which she describes as a “balance between oncologic control, treatment harms and quality of life.”
The therapy uses ultrasound waves to destroy cells in very specific, targeted areas. By precisely moving the focal point of each wave, it is possible to destroy a volume of tissue (partial or whole prostate gland) without damaging surrounding tissue.
Possible side effects with HIFU include urinary tract infection, scar tissue formation and erectile dysfunction.
The rate of cancer recurrence with HIFU has also been shown to be higher than aggressive treatment so patients could require a second treatment, radical prostatectomy or radiation.
A potential complication is rectal injury due to the high heat moving through the rectum, according to Scarpato.
“Several centers are using HIFU after other therapies have failed,” Scarpato said. “I believe it’s a reasonable approach following radiation. The reason I hesitate to use HIFU for salvage therapy, at least initially, is that the tissue has already been subjected to some therapy and the tissue quality is likely compromised, so this may be associated with a higher risk of a rectal injury.
“Hopefully, in the near future, we’ll have meaningful data to support HIFU as a first-line treatment for qualifying patients,” she said.
