Non Surgical Prostate Cancer Treatment Prostate HIFU

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One of Our Patients MRI Data Before and After the HIFU Procedure

Before

Arrows demonstrate the prostate cancer.

After

The area of the tumor focus and its surroundings have been completely destroyed (Arrows). Other parts of the prostate gland that do not contain cancer are preserved.

Have you ever used a magnifying lens to open up a tiny hole on a leaf? The same principle is also valid for HIFU.

HIFU uses sound as the source of energy instead of sunlight. HIFU is a transducer to direct and focus energy instead of a magnifying lens.

What is HIFU treatment?

High-intensity focused ultrasound (HIFU) uses high intensity ultrasound energy to destroy cancer cells in prostate. A beam of ultrasound energy reaches prostate via a probe placed in anus (rectum).

High-intensity sound waves form heat by focusing on a specific point. Given on a specific location in the body, HIFU energy reaches up to approximately 195 degrees Fahrenheit in just a few seconds on the focal point. Thus the cancer tissue is destroyed without radiation or any surgical operation in the body, while the tissue besides the focal point remains unharmed. By this means intended treatment is given without harming the healthy prostate tissues surrounding the focal point.

This minimally invasive procedure is provided as an outpatient treatment.

What will happen during your treatment?

You will be sedated by general anesthesia during the treatment. If for some health reasons, you are not fit for general anesthesia, you may have spinal (epidural) anesthesia which will ensure that you will not to feel anything in your lower body.

During treatment you will lie on your back with your legs open or on your side with your knees drawn up to your chest. Your doctor or nurse will tell you which position you should take while lying down.

In order to empty your bladder, a catheter may be used in the beginning of the treatment. Catheter is a tiny tube that is inserted into your bladder through the penis.

Surgeon will insert a probe inside your rectum. The probe will give high-intensity ultrasonic energy beam to the prostate. Every time the beam is emitted, it will cure a small area of the prostate (10x3mm area cube). Surgeon will move the beam in such a manner to heat up and destroy the cancer cells.

On Whom HIFU can be used?

HIFU treatment is advised,

  •  On male patients who have early stage localized (T1 and T2) prostate cancer that has not spread out of prostate,
  •  On patients who don’t want to experience post-surgery problems of erection and urinary incontinence,
  •  On patients who are not fit for surgery (elderly patient, general health disorder, etc.),
  •  On patients who have relapsing cancer despite treatment methods like surgery and radiotherapy have been exhausted,
  •  On patients who don’t want to go through surgery,
  •  On patients who have previously had abdominal surgery.
  •  If your cancer is spread out of your prostate to other parts of your body (for advanced stage prostate cancer) this is not an option!

How many kinds of HIFU exist and what are these?

There are two kinds of HIFU treatment

1. Whole prostate gland HIFU; cures the entire prostate and it takes about three hours. It may be suitable for men who have prostate cancer that needs to be treated in more than one part of prostate.

2. Focal Point HIFU treats a smaller part of prostate and it takes about 1 to 2 hours. It may be suitable for men who have prostate cancer that needs to be treated on only one part.

Surgeon will treat cancer areas that needs to be treated and the small area surrounding it. Focal HIFU treatment harms healthy tissues less compared to the whole prostate HIFU procedure. Generally the counter anatomical parts are preserved in a complete manner since they are not subjected to any procedure.

Can HIFU treatment be started instantly on every patient?

If you have a large prostate, you will have a hormone treatment 2 to 3 months prior to HIFU procedure. This might downsize prostate and make cancer treatment easier.

Transurethral resection of the prostate (TURP) is a procedure to take out the prostate tissue and improve urine flow. This procure might be used also prior to HIFU to decrease the risk of some post-treatment urine problems.

What are other treatment methods for prostate cancer besides HIFU?

Active surveillance
Active surveillance is a way to monitor slow-growing localized prostate cancer rather than treating it straight away. The goal is to avoid or stall unnecessary treatment and side effects.

Surgical: radical prostatectomy
Radical prostatectomy is surgery to remove the prostate. It may be a surgical treatment option for men with localized prostate cancer.

Radiotherapy
It uses high energy beams like x-rays to treat prostate cancer.

Brachytherapy
It is a procedure that involves placing small radioactive bars in the prostate gland. It is called low-dose rate brachytherapy. Radiation coming from bars destroys cancer cells in prostate.

Yet there are many side effects of these treatment methods. Primary side effects of surgery is urinary incontinence and erection disorder. Side effects of radiotherapy can be problems like tiredness, hair loss, constipation, bleeding, frequent need to urinate and urinary burning.

What are the advantages of HIFU compared to traditional prostate cancer treatment methods (surgical, radiotherapy)?

  •  Risk of complication is low. It gives the opportunity to intervene cancer tissues without harming the surrounding organ and tissues.
  •  It provides an important advantage in preserving sexual life and bladder control.
  •  There is no blood loss and pain.
  •  There is rapid recovery. Patients are discharged the same day or one day after at most. Whereas they stay in hospital for 3-4 days after surgery.
  •  It is a nonsurgical procedure. It is a good option for those patients who don’t want to go through surgery or who are not fit for surgery (elderly patients)
  •  There is no incision.
  •  It involves no radiation contrary to radiotherapy and it is a one-session procedure.
  •  Radiotherapy lasts for 30 days and the patients need to come to hospital almost every day.
  •  Outpatient procedure is conducted.
  •   HIFU treatment may easily be carried out even after tumor regenerates after surgery, radiotherapy or HIFU treatment.
Benefits to The Patient
  •  Reduced risk of incontinence
  •  Reduced risk of erectile dysfunction
  •  Preservation of ejaculation
  •  Maintenance of prostate tissue
  •  Minimal invasive procedure
  •  Shorter period of procedure
  •  Outpatient treatment
  •  Rapid recovery
  •  Goes back to work in a few days.

What kind of preparation is necessary prior to HIFU treatment procedure?

Patient should use antibiotics one day before the procedure and should not eat or during 6 hours prior to the procedure. You will be given enema to empty your bowels in the morning of your HIFU treatment.

How much time does the treatment take?

It lasts for approximately 1,5 – 2 hours yet the procedure time may vary according to the size of the tumor to be burned.

Is HIFU treatment painful?

The treatment itself is not painful since it is carried out under general anesthesia. Rarely there might be post-treatment pain, most patients feel a slight disturbance which heals after a few days. Since the procedure is not interventional there are no incisions or scars.

How much time does it to return to normal life after HIFU treatment?

Our patients are discharged on the day of procedure of after 1 day. Our patients can generally stand up and walk a few hours after the procedure.

What are the side effects of HIFU?

There are far less side effects after HIFU treatment compared to other invasive procedures (surgery, brachytherapy etc.). Side effect rates are much less done by the hands of experienced surgeons.

Though rarely, side effects such as urinary problems, erection and maintenance of erection (erectile dysfunction) are noted in literature.

During focal HIFU procedure, healthy tissues are less harmed compared to whole prostate HIFU, therefore it has fewer side effects than whole prostate HIFU.

Blood and tissue in urine: While catheter is in place, you might see some blood in your urine. 6 to 8 weeks after HIFU procedure, you may see some small prostate tissue in your urine. This is normal. Yet if you get anxious, please consult your doctor.

Erection problems: Very seldom erection and maintaining erection (erectile dysfunction) problems might be observed in some patients after HIFU procedure. The reason for this is that the procedure might harm some blood vessels and nerves that control erection. For some men this is a temporary problem. Yet sometimes the side effect might be a longer-term problem.

Urinary infections: Some men have urinary infections after HIFU procedure. The symptoms of a possible urinary infection are:

  •  Fever (high temperature)
  •  Burning feeling when urinating
  •  Dark or blurred urine with a strong odor
  •  Need to urinate more frequently than usual

If you have any symptoms of a urinary infections, please consult your doctor. He will generally treat you with antibiotics.

After your treatment

You may go home on the same day of procedure or the next day. Very seldom patients might feel pain, yet you will be given pain relievers that you can take at home.

You will also take antibiotics to prevent any possible infection and you might also be given laxatives to help you empty your bowels.

HIFU procedure generally causes prostate to swell and this might make urinating hard. A catheter will be inserted to help you empty the urine in your bladder until swelling is over (it is generally taken out 5 to 7 days after the procedure).

Your doctor or nurse will show how to use your catheter before you go home.

How is follow-up after the treatment?

Catheter is taken out 3-7 days after the procedure. PSA levels should be checked every 3 months.

In order to check if your prostate cancer is cured or not, you will have prostate MR in specific periods after treatment.

In case of any clinical necessity prostate biopsy might be used to confirm.

If cancer cells are existent, a second HIFU treatment can be used.

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