For the estimated 220,000 men who will be diagnosed with prostate cancer this year, deciding on a method of treatment can be a challenge. Some with early-stage cancer pursue a "wait and watch" option, also called active surveillance, while others with more severe cancer immediately pursue surgery, including prostatectomy (removal of the prostate). Others fall somewhere in the middle. For those men, an exciting new, minimally invasive therapy might be an optimal treatment approach.
High intensity focused ultrasound (HIFU), or focal therapy, is a new concept for treating prostate cancer pioneered by clinician-scientists at NYU Langone Medical Center. The goal is simple: Destroy only the clinically significant cancer within the prostate while sparing adjacent structures and minimizing side effects, such as erectile dysfunction and urinary incontinence.
"This technology provides important treatment for a niche group of men with prostate cancer who otherwise have limited options for care," says Herbert Lepor, MD, the Martin Spatz Chair and Professor of Urology at NYU Langone. "It was rewarding to see our first patient leave our out-patient facility in the afternoon, enjoy dinner with his wife that night, and report no adverse impact on erectile function three days later."
Earlier this month, Dr. Lepor and colleagues at NYU Langone were the first in the Northeast to utilize Sonablate®, a new focal therapy device, to treat patients with intermediate-risk prostate cancer. Manufactured by SonaCare Medical, Sonablate® uses focused ultrasound energy to destroy prostate tissue at the focal point without harming the tissue around the lesion.
How HIFU Works
During the HIFU procedure, a diagnostic and therapeutic ultrasound probe is inserted into the rectum under general anesthesia. The surgeons direct the focused ultrasound energy precisely to the cancer under real-time ultrasound guidance, which is co-registered to the original MRI that was used to plan the extent of the tissue ablation. The innovative co-registration fusion software allows the surgeon to ablate the targeted cancerous tissue and a rim of normal tissue, minimizing damage to untargeted tissue.
Upon completion, the surgeon is able to analyze the results in real time using ultrasound imaging and monitoring software that tracks changes in the tissue. Once satisfied with the ablation, the surgeon removes the probe and the patient is transferred to recovery.
"Building upon our pioneering work in prostate imaging and targeted biopsy, this technology adds an innovative, minimally invasive treatment option to the array of modern treatment choices we can offer our patients," says James Wysock, MD, an assistant professor of urology and a urologic oncologist at NYU Langone certified in HIFU ablation. "We will continue to study this therapy and identify better ways to screen, detect, and treat the disease."
NYU Langone Medical Center