Why HIFU?

Peter Sinaiko MD FACS | HIFU Therapy
21 Sep 2011

I have been treating prostate cancer for over 35 years using every available modality during that period of time to treat thousands of patients. Today HIFU, High Intensity Focused Ultrasound, represents the ultimate prostate cancer treatement because it is applicable in nearly every instance where prostate cancer is limited to the prostate gland without distant spread. It works in a way that preserves a patient’s quality of life and allows him to rapidly return to his pre-treatment vitality.

First let me explain what HIFU is and how it works. HIFU harnesses ultrasound in such a way that it can be used to destroy prostate cancer tissue. It does so by means of heating the tissue to a temperature for a period of time that will allow the destruction of the living cells that comprise the prostate and the prostate cancer. Once these cells are converted to a “proteinaceous slurry,” they no longer pose a risk to the host. This is accomplished by placing an ultrasound probe capable of emitting high-powered ultrasound in the rectum. Converging ultrasound beams, created by a transrectal probe travels through the tissue until it reaches the prostate. At that point the beams converge creating the heat necessary to destroy tissue. These beams are absolutely harmless to the patient until they converge in the prostate. Each convergence destroys a portion of prostate measuring .09 cubic centimeters. Tissue adjacent to each of these convergences is left completely unharmed. The Sonablate 500, the most advanced HIFU device available, first maps out the prostate and divides it into .09 cubic centimeter targets. Once this is completed the device is commanded by the operator to destroy each of these targets in a systematic manner.

The sum effect of ablating all of the targets in the treatment plan is to completely destroy all targeted prostate tissue without injuring adjacent organs. Additionally, the HIFU probe is able to detect the nerves and blood vessels which are adjacent to the prostate and are responsible for erectile function. These structures are excluded from the treatment plan and therefore remain functional. In addition, imaging of the urethral sphincter allows for its preservation and the maintenance of urinary continence i.e. control.

In order to ensure that tissue has effectively been destroyed, the Sonablate 500 has a tissue change monitoring system built into it. The Sonablate planning function allows the doctor to target as close as 3 millimeters from a structure without damage to it. As each target is destroyed, the TCM system looks at the tissue to assure that change in the tissue has occurred. If there has been insufficient change, then the Sonablate 500 has the ability to go back and treat that specific target to ensure complete destruction.

Like any other prostate cancer therapy, if the tumor has spread or metastasized beyond the prostate, local therapy can not cure the disease.

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