Doctors using ultrasound to battle prostate cancer
It’s the second most common type of cancer among men and affects 1 in every 8 men in the United States. September is Prostate Cancer Awareness Month, and the American Cancer Society says this type of cancer is often asymptomatic and only detected by a blood test and biopsy. Commonly diagnosed in men over age 65, prostate cancer risk also increases with age. Now, urologists at Allegheny Health Network (AHN) are the first in Western Pennsylvania to start using a new focal therapy to treat prostate cancer.
What is HIFU?
Doctors can often cure prostate cancer using a range of treatments that may include radiation therapy in combination with surgery to remove the entire prostate gland, called radical prostatectomy. Surgeons can perform robotic-assisted prostatectomies allowing them to make only a few small incisions.
Now, a new ultrasound treatment is making treatment even less invasive. High-intensity focused ultrasound (HIFU) treatment is used when a patient is in early stages of prostate cancer. It’s minimally invasive and patients are often discharged the same day with short recovery periods. Sonablate® HIFU, often referred to as focal therapy, uses high-frequency ultrasound waves to target and destroy cancer cells in the prostate while protecting the surrounding tissue. Performed under general anesthesia, doctors insert an ultrasound probe into the rectum to direct ultrasound waves at the cancerous tissue.
“Most patients undergoing this therapy are able to go home the same day as their procedure and fully recover in about five days,” says AHN urologist Dr. Ralph Miller, who first performed focal therapy at Allegheny General Hospital last May. “We are fortunate to have a variety of good treatment options for prostate cancer, particularly when it’s diagnosed early, and this is one that can help some patients avoid the risks and side effects of traditional surgery, chemotherapy and radiation.”
Miller said the ideal candidate for focal therapy typically has low- to- intermediate-risk prostate cancer, located in only one area of the prostate and that has not yet spread to other areas of the body. Because it is a highly targeted and localized treatment, patients are less likely to experience side effects that are often associated with more invasive treatments, such as urinary incontinence and sexual dysfunction.
A recent study among patients with non-metastatic low to intermediate prostate cancer showed outcomes over eight years were similar between focal therapy and radical prostatectomy.
“High Intensity Focused Ultrasound (HIFU) can kill prostate cancer tissue by heating the tissue in a small, controlled area rapidly to a high temperature,” Miller said. “Results of focal HIFU at AHN are preliminary, but promising. It is widely used elsewhere in the U.S. and Europe and compares favorably to the standard treatment options, although the follow-up is not as long as it is with the standard treatment options, like radiation and surgery.”
Miller said not all patients with prostate cancer are candidates for HIFU. Currently about 25% of prostate cancer patients may be candidates, but this percentage may increase in the future after more research.
When to screen
Current guidelines for prostate cancer recommend screening for men ages 50 to 70 who have at least a 10- to- 15-year life expectancy. Screening should begin at age 40 for men with a family history of prostate cancer or men of African descent. Annual screenings include a PSA blood test and a digital rectal exam.
“Prostate cancer is usually detected early on during preventive screening,” Miller said. “The prostate-specific antigen (PSA) blood test measures the level of PSA in the blood. If those levels are elevated, that may be an indication of prostate cancer or another condition that can affect the prostate. The second test is a digital rectal examination, which allows us to feel for enlargement, nodules or abnormalities.”
While there are no symptoms specific to prostate cancer, some patients may experience a rapid decline in the force of their urinary stream with the onset of prostate cancer.
Men over age 70 do not have to have regular prostate cancer screenings. “Men who we screen should have a life expectancy of at least 10 to 15 more years,” Miller said. “The reason we consider this factor is because prostate cancer is a slow-growing cancer, and with an early-stage diagnosis, a man can go several years before it becomes life-threatening. Statistically, the ability to extend a man’s longevity drops as he ages. Treatment for prostate cancer does come with risks, especially as patients age. So, we wouldn’t treat a patient if we didn’t think it would impact their life expectancy or improve their quality of life.”
If recommended, the next step in screening would be a prostate biopsy sample. “We insert a needle through the skin and into the prostate to draw out samples of tissue,” Miller said. “The entire procedure usually takes about 15 minutes.”
If results are positive, AHN has a multidisciplinary team of experts in radiation options, as well as chemotherapy and immunotherapy who collaborate with the urology team to create a unique care plan for each patient. Fortunately, the first method to consider is active surveillance.
“For those with low-risk prostate cancer, we closely monitor and regularly follow up with screenings,” said Miller. “For those with intermediate prostate cancer, which is usually localized and hasn’t spread beyond the prostate, we use traditional therapy options like surgery or radiation. Patients with intermediate prostate cancer may be a candidate for our new high-intensity focused ultrasound (HIFU) therapy.”
Patients with high-risk prostate cancer usually require surgery, radiation, medical therapies, or combinations of therapies.
“We offer minimally invasive treatment options for most patients who require surgery,” Miller said. “With localized cancer, we often utilize our robotic surgery tools.”
With HIFU treatment, most patients are able to go home the same day as their procedure and fully recover in about five days.