Focal Therapy: High-Intensity Focused Ultrasound for Prostate Cancer (HIFU)

UF Health understands the value of staying at the forefront of cancer care. With the rapidly evolving options available for localized prostate cancer, our urological cancer experts are putting these words into action by offering a variety of focal therapy options. The goal of focal therapy is to specifically target the cancer tissue within the prostate while leaving harmless prostate and surrounding structures untouched. This ultimately minimizes the side effects that may occur when we treat the entire prostate. Our urological oncologists are a part of the UF Health Cancer Center, an NCI-designated cancer center. Only cancer centers that meet the highest standards for research and development in creating innovative approaches to cancer diagnosis and treatment achieve this level of distinction.

What Is High-Intensity Focused Ultrasound (HIFU)?

HIFU is a type of focal therapy we use to treat prostate cancer. There are a variety of focal therapies used to treat prostate cancer. All of these treatment types seek to:

• Treat only the cancer cells in the prostate without damaging surrounding tissue.
• Spare the surrounding urological structures that are responsible for erectile function and urinary continence.
• Offer a less-invasive treatment to select patients with localized prostate cancer.

HIFU uses high-intensity focused ultrasound waves to specifically target and ablate prostate tissue in a way similar to a magnifying glass focusing harmless light into a very hot focused location. The targeted area in the prostate which contains the cancerous cells thus receives focused heat that destroys the cancer cells through a process called coagulative necrosis. Because the heat is pinpoint focused and planned out carefully, the surrounding healthy prostate tissue, nerves of erection and muscles of continence are ultimately preserved. This hopefully leads to ablation of cancer cells while optimizing quality of life through the minimization of patient side effects.

Who are candidates for HIFU treatment for prostate cancer?

Patient selection for Focal Therapy and HIFU are carefully selected by our urologic oncologists. Patient characteristics including past medical and surgical history, as well as a history of latex allergy are all considered during this process. Disease characteristics including the PSA, Gleason Score, number of cores with prostate cancer, core location and prostate Magnetic Resonance Imaging (MRI) features are all important considerations for the determination of suitability for this treatment process.

How does focused ultrasound work?

Think about how when rays of sunlight pass through a magnifying glass and are concentrated on one point. This causes the temperature to rise but only in a specific focused location.

We offer HIFU treatment at UF Health as one of multiple focal therapies. The treatment process includes:

• Imaging the prostate: Prior to consideration, a prostate MRI is performed. Once this is done, the entire prostate is scanned in real-time using a transrectal ultrasound imaging probe. The combination of both those imaging modalities are then superimposed in a process called MRI-3D ultrasound fusion. This image will be displayed on the screen of our robot system in a three-dimensional reconstruction. This will allow the physician to know the location of your tumor and the borders of your prostate and other vital structures.
• Prostate cancer treatment planning: After rendering the fused reconstruction, the urologist treating the patient will plan each step of the procedure to precisely target the area of concern and to ensure each HIFU energy delivery is targeted on the cancer while minimizing energy to surrounding structures.
• Focal HIFU energy delivery: Once this is planned out by the urologist, the automated HIFU system will determine the optimal number of prostate slices to treat and then produce very tailored and directed high-intensity focused ultrasound waves to destroy the targeted cells.

What are the advantages to HIFU treatment for prostate cancer patients?

The technological advancement that makes HIFU a great treatment option for prostate cancer is that it only ablates the cancer cells. This means that it helps preserve your quality of life as it minimizes the effect on surrounding systems including nerves of erection and muscles of continence. The real-time imaging helps our urological surgeons precisely ablate the affected areas in one session while adjusting any necessary treatment borders in real-time. While this procedure is performed under general anesthesia, this is a same day procedure, meaning that patients go home shortly after the procedure is complete. The duration of time a patient has a catheter is generally less than radical prostatectomy duration. Finally, there is lower rates of side effects when compared to other radical treatment methods for prostate cancer.

What happens after the HIFU treatment for prostate cancer?

After the procedure is over, a temporary urinary catheter is placed to help limit the risk of urinary retention that may happen due to temporary swelling. You will be discharged and can normally return home the same day. The catheter will be removed at your follow-up visit at our urology clinic a few days later.

We will run a PSA test at three months, six months and one year after the procedure. Additionally, we will do MRI imaging and potentially some follow-up biopsies at the six-month and one-year mark. This follow-up can be performed by your urologist at UF Health, or if you traveled from a farther location, your local urologist.