Could I Be Suitable For HIFU Treatment For Prostate Cancer
Men with localised biopsy proven prostate cancer, who understand the treatment options of robotic/radical prostatectomy, brachytherapy, radiation therapy, or active cancer surveillance, and accept the relatively minor risks of HIFU treatment, are considered suitable for HIFU.
The following are important selection criteria;
- Clinical Stage T1-T2 N0 M0 (localised prostate tumours)
- Gleason score 6 (3+3),7(3+4), 7(4+3), 8(4+4)
- Preferably less than 50% prostate biopsies involved with cancer
- PSA less than 15 ng/ml
- Prostate volume less than 40cc and minimal prostate calcification (measured on transrectal ultrasound scan)
- No underlying prostate obstruction to urine flow. Some men require preliminary TURP to remove part of the prostate prior to HIFU.
- Previous TURP even years ago is ok
- Previous failed external beam radiation therapy is ok, as HIFU suitable for salvage treatment.
- No active disease of the anus/rectum
HIFU Case Studies
Mr PS age 67 married, occupation farmer, diagnosed with prostate cancer in 2019 with PSA 5.9 and Gleason score 4+3=7 in 8 of 14 transperineal biopsy cores.
Prostate MRI scan reported a prostate cancer in both lobes and very close to prostate capsule and erection nerves, but no spread to pelvic lymph nodes or bones.
This was confirmed with a PSMA PET scan which showed the prostate cancer localised to prostate gland and no metastases to seminal vesicles, lymph nodes or bony skeleton.
His Urology surgeon advised Robotic Radical Prostatectomy, and a Radiation Oncologist advised Brachytherapy Radioactive Seeds Implant as treatment options.
He was concerned about the risks of urinary incontinence ( 5 % severe, 20% with pads) and loss of sexual function ( 50-100%) with surgery.
Initially he was more accepting of Brachytherapy until he discovered that if the cancer recurred after Brachytherapy, then he could not safely have salvage surgery. Brachytherapy also has significant Late Onset Complications after 5-10 years, such as severe bleeding from bladder, urethral strictures, rectal fistula and second cancers in bladder or prostate from the radiation (think Hiroshima and thyroid cancer and leukaemia).
Learning of HIFU treatment from a friend who had HIFU years ago, they advised him to seek further information.
Long story short, he was treated with Whole Gland HIFU Prostate Ablation in 2019.
The HIFU treatment was planned to include all of the prostate gland since the tumour was in both prostate lobes, with careful preservation of the urinary sphincter, rectal wall and erection nerves.
He stayed in hospital overnight, and returned to the Urology suite 3 days later for removal of the urinary catheter. He returned to farming activity 2 weeks later and recovered normal bladder control immediately. He took Viagra tablets for next 12 months and fully recovered sexual function with normal erections.
The PSA level dropped from 5.9 before HIFU to <0.03 after 3 months and 0.05 after 2 years indicating excellent prostate ablation. He remains on 6 monthly PSA checks with no further treatment and normal Quality of Life.
The longer term outcomes of Whole of Prostate Gland HIFU Ablation for Prostate Cancer have been published in Prostate International 2020, Royce et al
Mr LR age 60, married, self employed tradesman, diagnosed with prostate cancer in 2017, with PSA 6.4 and Gleason score 3+4=7 in 7 biopsy cores from a 12 mm prostate cancer at the prostate apex near to the urinary sphincter as seen on MRI scans.
His Urology surgeon advised Robotic Radical Prostatectomy, however he decided to wait and see how the PSA level behaved before deciding on treatment.
He consulted a Radiation Oncologist in 2019 when his PSA increased to 7, however a repeat prostate MRI scan showed a stable 12 mm prostate cancer, so he declined to have Brachytherapy Radioactive Seed Implant.
Later in 2019 his PSA increase further to 9.9, so at this point he decided it was time to have treatment for prostate cancer before it was too late, but he did not want to have a high impact treatment with surgery or radiation.
He then Googled prostate cancer treatment, and discovered the Melbourne HIFU Website
Long story short he was treated with Focal HIFU Ablation in 2019.
His treatment plan included the known cancer at the prostate apex, with careful preservation of urinary sphincter, rectal wall and erection nerves.
He stayed in hospital overnight and returned to the Urology suite 5 days later for removal of urinary catheter. He returned to work activity 2 weeks later with normal bladder function and control.
He used Viagra tablets for 1 year with return of normal erections, and no longer needs Viagra.
His PSA dropped from 6.4 to 1.39 and remains lower at 2.32 after 18 months.
More importantly repeat prostate MRI scans have reported no residual prostate cancer.
Further prostate biopsy or treatment has not been required, and he remains on regular surveillance with excellent Quality of Life and much less anxiety about his future.