HIFU - an effective treatment for prostate cancer

HIFU - an effective treatment for prostate cancer

A review of HIFU, or High-Intensity Focussed Ultrasound, a form of ablation which uses sound waves as a non-invasive, non-surgical heat treatment for prostate cancer - including treatment details, applicability, side-effects, treatment centres and costs; HIFU offers dramatically reduced side-effects and a cure rate of over 95%; it is thus an effective alternative treatment to standard prostate cancer surgery. Learn more.

HIFU and ablation can melt away localized prostate cancer

Ablation is the use of heat to kill cancer tumours; it is localised Hyperthermia. There is thermal ablation where Doctors heat the cancer cells to 45, 50 or 55 degrees C; and there is cryoablation where doctors use a feezing gas at -40 degrees C. In both cases, a probe is inserted through a tiny (3mm) hole made in the skin.

High Intensity Focused Ultrasound or HIFU uses the frequency of sound waves to heat up the cancer tumours and kill them. No probe necessary. The proceedure may last just 90 minutes and patients can return home in a few days. But the biggest benefits are that it is effective and far less likely to cause impotence or incontinence. It is thus a highly effective alternative to radical prostate cancer surgery (Radical Prostectomy).

At CANCERactive, we have championed HIFU since 2005. We were the first UK Cancer Charity to do this.

HIFU and ablation melt away localized prostate cancer"

First, let's get the terminology clear.

Hyperthermia is an approved complementary cancer treatment recommended by both the National Cancer Institute and Sloan Kettering in New York. Since William Coley in 1920 at Sloan Kettering, it has been thought of as a whole body treatment.  

Ablation is the localised form and Thermal Ablation uses heat to kill local tumours. Cryoablation uses a freezing gas. 

Focal Laser Ablation is used to treat prostate cancer. The cancer needs to be confined to the prostate, the Gleason 4/3, or less, and the patient is sedated. The 1.6 mm laser is then inserted under anestheic into the prostate, guided by MRI imaging. Before treatment you will have had an image guided biopsy. There are a good number of Laser Prostate Centers in America; increasingly all major Hospitals use it. In the UK we have the Focal Therapy Clinic.  That's about it! See the end of the article for details.

HIFU is a non-invasive way of delivering the heat to kill tumours and thus is a largely non-invasive form of Thermal Ablation. Most centres do use a catheter, a drain, to take away blood from the area though during HIFU. You may also be given antibiotics.

Thermal Ablation, cryoablation, HIFU and prostate cancer in the UK 

Back in 2004, in icon magazine, we briefly covered the news of this ’breakthrough’ therapy called HIFU, a form of Ablation being covered by the British Media. By March 18th 2005 there was an Istanbul conference, and the European Association of Urology (EAU) launched a ’club’ of top Urologists across Europe to support and develop this highly promising, non-invasive treatment. As Chris Woollams, a founder of CANCERactive and a former Oxford University Biochemist says, "They wrote to me asking if I would look into the treatment and support it. I did more. I have ’Championed’ it for the men of Britain! It has barely got off the ground in the UK. Politics has been a huge factor."                                                 

In its simplest form, private clinics in Europe started using Ablation back in 2000, for example using a plastic catheter pushed up the penis to position a metal probe into the middle of the prostate. This could then be heated killing the surrounding cancer cells. Simple, cheap, effective. By 2005 over 7,000 patients had been successfully treated using this therapy in places such as Germany, Switzerland and Russia. There were claims of 100% effectiveness or 75% if you had had a biopsy. You were also commonly given Androgen Deprivation Therapy for a year or two, so it was rather hard to be clear about what was working.

Go to: Richard Beavan goes to Klinik St. George for Prostate Ablation 

By 2009 Clinical Trials on HIFU in the UK, taking newly diagnosed prostate cancer patients (where the cancer was small and confined to the prostate), showed that although surgery was effective with these people (although not recommended by the likes of Sloan-Kettering and the Royal Marsden, who preferred ’Active Survilance’), HIFU was just as effective and had the advantage of significantly lower levels of side-effects. At that time a wider Clinical Trial was started at MD Anderson in Texas.

In 2018, as I write this, a Directory of Locations for Ablation shows that the USA has 254 centres, Germany 46, France 66.  

We have had two or three in the UK for HIFU, and one of those seems to have closed already. A number of UK Hospitals do offer ablation and cryoablation, but not for Prostate cancer.

HIFU for prostate cancer - far less side effects and a potential cure

The first thing to understand is that your tumour should be confined to the prostate if you are considering this treatment.

Secondly, as we said above, although some German clinics talk about 100% success in terms of ablation killing the cancer cells, they lower this figure to 75% if you have had biopsy. Why? Because biopsy can spread a prostate cancer as it punctures the capsule around the prostate, allowing cancer cells to escape. Many of them require patients to take an androgen suppressing drug for at least a year because of possible spread. There was clear research in the nineties from Guy's Hospital, London on biiopsy causing spread.

Next, from this moment on in this overview, we are going to separate real High Intensity Focussed Ultrasound (HIFU) from more simple heat treatments (Ablation).  Ablation can be as effective and considerably less expensive. Ablation in Germany can cost 6,000-8,000 Euros; HIFU in America $25,000. For UK centres, see the end of the article.

Top American Hospitals routinely extend the HIFU to a small distance around the prostate in order to kill any escaped cancer cells. At First Urology, Dr. John Jurige (who is based in Louisville, Kentucky), claims that in 100% of cases he preserves the nerves (resulting in no erectile disfunction) and incontinence occurs in less than 5% of patients. He has treated over 1,500 patients with HIFU.

Go to: John Jurige at First Urology

Similar numbers have been treated at MD Anderson. The man to go to in Texas is Dr James Cochran, who holds free education webinars; and the website to go to for these is - https://www.texashifupartners.com/. Dr. Cochran first used Sonablate therapy in 1999; and HIFU was approved by the FDA for prostate cancer treatment in 2015.

In Chicago, the University of Chicago immediately started using HIFU under the heading of ’robotic surgery’. 

In Los Angeles there is Dr. Pugach and his assistant John Linn. They have over 1200 procedures behind them.

Go to: Dr Pugach Free Webinar on HIFU

Frankly, the UK is being left behind.

Ablation and HIFU treatment details

HIFU treatment happens just once and lasts for about one and a half hours with patients being admitted the night before and leaving hospital two to three days later. This in itself is a major benefit to patients - shorter time in hospital, being able to walk out easily and comfortably. One issue is that most US centers require the patient to take 12-20 days of antibiotics. A catheter can stay in place for as long as 20 days and hence the antibiotics. Many people in the health community would say this in itself was invasive as it will destroy commensal gut bacteria.

Ablation requires no Hospital stay; people usually find a hotel near the clinic. You may have the treatment twice - several days apart.

An endorectal probe is introduced while the patient is under general or spinal anaesthesia. Ultrasound scanning is used to locate the exact area of infection and then high intensity focussed ultrasound transmissions are applied to raise the temperature of the localised area to 85 to 100oC. This induces necrosis of the affected prostate tissue. Reports suggested that the tumour and infected cells liquefy. The treatment is a precise local treatment, involving in just one session and is minimally invasive with no side effects. Only a few complications have been reported to date and patient recovery time is short. Furthermore, the treatment may be repeated. 

One patient using CANCERactive’s Personal Prescription service went to Klinik St Georg and had treatment. When he returned to the UK, about 9 months later he had a full biopsy. The UK oncologist confirmed that all prostate cancer cells were dead.

Open quotes95% of patients have none of the problems associated with prostate surgery - they are cancer free, with no urine leak plus good erectile functionClose quotes
"HIFU Technology for the treatment of prostate cancer is very promising, as is demonstrated by the high rate of success that we experience in Munich", stated Dr Stefan Throff of the Krankenhaus Munchen Harlaching. That success is a staggering 87 per cent without relapse at five years.

Another positive of the treatment is that nadir PSA is reached after only 3 months and so success is more quickly established.

UK Clinical Trial on HIFU - 95 per cent success

Sadly, some personal friends who have enquired about HIFU as a treatment in the UK have heard it ’rubbished’ by UK oncologists as if it is some sort of quackery. These people have no idea of what is going on in the world - these excerpts are from a news item that appeared in Cancer Watch (Latest News) on this website as reported in the Journal of Urology as long ago as Monday 4 April 2011.

"Researchers at UCL (University College London) and clinicians at University College London Hospitals NHS Foundation Trust (UCLH), successfully used High Intensity Focused Ultrasound, or HIFU treatment, to target only cancerous tumours and minimize the damage caused by traditional surgery or radiotherapy.
This is the first trial of its kind and the results showed significantly reduced harmful side effects and positive results in terms of cancer control.
After 12 months, 90 per cent achieved the perfect result called the trifecta status - of having no urine leak, having good erections and being cancer free. In fact, 95 per cent of the participants, all UCLH patients, were able to maintain erections sufficient for intercourse and no participants reported back-passage problems.
Early cancer control was also very promising.  Ninety per cent of men had no cancer on tissue samples taken after treatment, while 100 per cent had no important cancer.
Professor Mark Emberton, chief investigator for the study and clinical director for cancer services at UCL, added, Our early trial results have shown that 95 per cent of men have none of the long term problems associated with the more invasive treatments such as leaking urine or poor sexual function. This cannot be achieved by any other standard treatments."

Go to:  An exclusive interview with Professor Mark Emberton

To put this all in context, prior to this treatment’s emergence, UK 5-year survival rates for prostate cancer were 54 per cent. Certainly it seems more user friendly than traditional surgery.

HIFU in the UK?

You could contact Professor Mark Emberton at University College, London - https://iris.ucl.ac.uk/iris/browse/profile?upi=MEMBE52

You could also contact the Focal Therapy Clinic - Tel: 020 7036 8870; Website: https://www.thefocaltherapyclinic.co.uk


Further reading

Go to: Ablation as a cancer treatment

Go to: A review on Hyperthermia

HIFU - an effective treatment for prostate cancer
CancerAcitve Logo
Subscribe (Free e-Newsletter)

Join Chris'

Join Chris' NewsletterSignup today for free and be the first to get notified on new updates.