When Fred Hutchinson Cancer Center launched its high-intensity focused ultrasound (HIFU) program last year under the leadership of urologic oncologist, George Schade, MD, it became the only medical center in Washington state to offer the procedure.
Now, HIFU is finally gaining traction in the U.S. after a long history of use in Europe and Asia and FDA approval in 2015. As an HIFU expert, Dr. Schade has been researching next generation HIFU technologies for more than 10 years, most of that time with engineers at the University of Washington’s Applied Physics Lab.
Because it is noninvasive and uses non-ionizing sound waves that have fewer side effects, HIFU is popular among patients who increasingly seek this therapy over surgery and radiation. Insurance coverage is also improving, Dr. Schade says. Medicare and some private payers now cover the procedure.
HIFU: Leading-edge Prostate Treatment
HIFU uses a transrectal approach to target the prostate with a high-intensity beam of sound energy. The transducer concentrates ultrasonic energy onto a small area of tissue and destroys it with heat. Outside that area, energy levels are low and the tissue is unharmed.
At Fred Hutch, Dr. Schade has access to the most advanced HIFU technology available — the Focal One. This device has several features, including:
- A greater range of depth: The Focal One has a greater maximum and shorter minimum depth. The expanded range benefits patients with larger prostates. It eliminates the need for hormone therapy or transurethral resection to shrink the prostate prior to HIFU treatment. A shorter minimum depth also enables the treatment of tumors that lie close to the rectal wall.
- Post-treatment contrast-enhanced ultrasound: An ultrasound with contrast performed after treatment highlights blood flow through the prostate. The ablated section shows up as a black hole. If there are any bright spots in the targeted area, Dr. Schade can apply additional HIFU treatment to destroy the entire tumor.
HIFU is an outpatient procedure that takes about two hours. “Recovery is usually quick,” says Dr. Schade. “The most common short-term side effect is swelling of the prostate. Patients go home with a catheter to help them urinate until the swelling subsides, which takes about a week.”
Precision Tumor Mapping Using MRI Imaging
Another feature of HIFU is MRI fusion, which uses an MRI image uploaded to the HIFU device. During the procedure, the device performs a 3D ultrasound scan of the prostate and combines it with the MRI image. This picture allows Dr. Schade to precisely plan treatment to target the tumor and a border area around it.
The success of tumor mapping in HIFU relies heavily on the quality and interpretation of MRI images. For this, Dr. Schade looks to Fred Hutch’s radiology team, who have access to the latest MRI equipment and protocols. They also have extensive expertise annotating images.
Throughout the procedure, Dr. Schade continuously monitors progress. “The prostate might move a bit or shrink during the procedure,” he says. “We watch closely and pause to adjust the treatment plan as needed.”
Modern HIFU Reduces Sexual and Urinary Side Effects
Compared with surgery and radiation therapy, HIFU reduces long-term side effects, including:
- Decreased sexual function: Among men who had normal sexual function before treatment, about 85% who received HIFU retained sexual function after HIFU versus 40% to 80% after surgery. For radiation therapy, the percent of men who retain sexual function declines over a three- to four-year timeframe. Once recovered, HIFU-treated patients do not typically experience non-age-related decline in sexual function.
- Urine leakage: Rates of urine leakage following treatment are lower (1%) with HIFU than both radiation therapy (2% to 3%) and surgery (10% to 15%).
The risk of urethral stricture and fistula is exceedingly low with modern HIFU therapy, compared with older HIFU technology, Dr. Schade notes.
Prostate Cancer Outcomes with HIFU
Patient outcomes have been difficult to measure, Dr. Schade says. “Prostate cancer is slow-growing and technologies are changing rapidly,” he says. “We don’t currently have any randomized trials comparing outcomes between HIFU, surgery and radiation therapy. But based on what we know, we think that cancer control with HIFU is similar to what we would expect for surgery and radiation.”
Currently, surgery and radiation are the standard of care for the treatment of localized prostate cancer, but Dr. Schade expects that will change with more data. A patient registry in Europe and early plans for similar registries in the U.S. may provide the data needed to establish HIFU outcomes.
Criteria for HIFU
Eligibility criteria for HIFU includes:
- Gleason score of 6 or 7
- Single focus
- Unilateral prostate cancer
HIFU is also an option for men who have localized recurrent prostate cancer after radiation. However, calcifications can block sound waves and may be a contraindication to HIFU if they are near the tumor.
Prostate Cancer Care at Fred Hutch
Dr. Schade evaluates patients for HIFU carefully to ensure they are good candidates. As part of the patient evaluation, he typically performs a repeat biopsy and MRI.
“I’m finding that many men who are initially interested in HIFU have a higher-grade cancer or more extensive involvement of the prostate than the original tests showed,” he says. “In cases where we need to treat a larger area of the prostate, it usually makes more sense to recommend surgery or radiation, since we have more data supporting it.”
Fred Hutch offers deep expertise in all types of prostate cancer treatments, including surgery and radiation therapy. Patients receive a personalized treatment plan and comprehensive, coordinated care.
Physicians at Fred Hutch’s Prostate Oncology Center, located at UW Medical Center – Montlake, are available to consult with community oncologists to discuss treatment options.
For patient referrals contact:
- Phone: (206) 606-8300
- Fax: (206) 606-2216
- Email: pccgu@fredhutch.org
- Online referral form
