High-intensity Focused Ultrasound for Prostate Cancer
High-intensity focused ultrasound (HIFU) is a minimally invasive technology that destroys cancerous prostate tissue.
Ablatherm HIFU treatment table and physician console allow precise targeting of prostate tissue.
Photo courtesy of Maple Leaf HIFU Co.
According to manufacturer information, three private clinics in Canada offer HIFU for prostate cancer treatment.
How it Works
While patients receive spinal or general anesthesia, a probe emits a precise beam of HIFU through the rectal wall to the prostate gland, creating a sudden temperature rise that destroys the targeted tissue. Real-time monitoring is done by ultrasound or magnetic resonance imaging (MRI). The HIFU procedure takes one to three hours and patients require urinary catheterization for seven to 14 days post-operatively.
HIFU is an alternative treatment to radical prostatectomy (surgical removal of part or all of the prostate) and radiation in men with well, or moderately differentiated, tumours and a life expectancy of more than five years.[2] Advantages include low complication rates, and the ability to repeat treatment or use additional interventions in the future. Used for either primary or salvage (recurrence) therapy, HIFU may be an option for those ineligible for prostatectomy.
Prostate Cancer in Canada
In 2006, about 20,700 Canadian men will be diagnosed with prostate cancer, and 4,200 will die from the disease.[1]
Regulatory Status
Health Canada has licensed two HIFU systems: Ablatherm® (EDAP TMS S.A.,Vaulx-en-Velin, France)in April 2003, and Sonablate® 500 (Focus Surgery Inc., Indianapolis, IN) in June 2005.
Evidence
Three small, non-randomized, uncontrolled trials report five years’ of experience with HIFU.[3-5] In the first trial, at 22 months of follow-up, 87% of 137 patients had low levels (<1 ng/mL) of prostate-specific antigen (PSA), which is a biologic marker for prostate tumours; and 93.4% had negative control biopsies.[3] In the second trial, involving 181 patients, biochemical disease-free survival rates (indicating stable PSA levels) were 84%, 80%, and 78% at one, three, and five years follow-up.[4] In the third trial, 65% of 242 patients had disease-free survival from 10 months to five years.[5]
Post-treatment impotence rates varied in the three studies: 52.7%[3] , 20% (of formerly potent patients not on hormonal therapy)[4] and 70%[5] of patients. Depending on the surgical technique used, about 60% of men experience impotence following prostatectomy.[6]
Recent conference presentations on ten years’ experience with 1,078 patients reported that 79.4% of men with locally advanced prostate cancer had negative biopsies following HIFU treatment.[7]
Cost
The Ablatherm unit costs approximately C$1M and the cost for the procedure (including physician, hospital and nursing fees, disposables, drugs, and accommodation) is C$21,580.
References
[1] Canadian Cancer Society. Prostate cancer stats. Toronto: The Society; 2006. Available: http://www.lcnd.ca/phase5/CCS/P5Frames.asp?source=http%3A%2F%2Fwww%2Ecancer%2Eca%2Fccs%2Finternet%2Fstandard%2F0%2C3182%2C3172%5F14471%5F371299%5FlangId%2Den%2C00%2Ehtml&site=1⟨=EN&log=20967
[2] Chaussy C, et al. Nature Clinical Practice Urology 2005;2(4):191-8.
[3] Blana A, et al. Urology 2004;63(2):297-300.
[4] Uchida T, et al. Int J Urol 2006;13(3):228-33.
[5] Colombel M, et al. Eur Urol Suppl 2006;5(6):491-4.
[6] Stanford JL, et al. JAMA 2000;283(3):354-60.
[7] Lecrubier A. High intensity ultrasound safe as first-line treatment for prostate cancer. [s.l.]: Cancerpage.com; 2006 Apr 11. Available: http://cancerpage.com/news/article.asp?id=9601