HIFU - an effective treatment for prostate cancer

HIFU - an effective treatment for prostate cancer

Treatment details, applicability, side-effects, locations and costs for HIFU, or High-Intensity Focussed Ultrasound, a form of Ablation using sound waves as a non-invasive, non-surgical treatment for prostate cancer offering dramatically reduced side-effects and a cure rate of over 95% are covered in this article; it is thus an effective alternative treatment to standard prostate cancer surgery

Ablation is the use of heat to raise the temperature of cancer cells and kill them. It is localised Hyperthermia, and commonly uses a heating probe pushed through the skin. Cryoablation kills cancer cells by freezing them instead. HIFU uses the frequency of sound waves to heat the cancer cells and kill them by ’liquifying’ them. The procedure does not involve a probe and only lasts about 90 minutes. It is thus an effective alternative treatment to standard prostate cancer surgery (writes Chris Woollams, CANCERactive). 

At CANCERactive, we have championed HIFU since 2005. We were the first UK Cancer Charity to do this. We have an exclusive 2011 interview with Professor Emberton at UCL, who conducted Clinical Trials, but politics and lethargy seem to hamper the mainstream use of HIFU in the UK.

The excitement over Ablation originally related to its growing use with localised prostate tumours, the speed of treatment, the minimal side-effects and the possibility of further treatments if necessary. Ablation has also been used as an alternative cancer treatment in kidney cancer surgery in the UK and other Western Countries. The potential is there in the longer term for any solid tumour such as breast cancer or ovarian cancer. It is even used cosmetically and has been through studies on bone metastases.

Yet, even today in the UK, many traditional doctors pooh-pooh this revolution in prostate cancer treatment. Not so, as we shall see, in the USA.

"HIFU and ablation melt away localized prostate cancer"

First, let's get the terminology clear.

Ablation a form of localised hyperthermia, or using heat to sensitise and even kill cancer cells. Hyperthermia is an approved complementary cancer treatment and is available as whole body, or localised.

Go to: A review on Hyperthermia

Ablation uses heat to kill tumours. Cryoablation uses a freezing gas. 

HIFU is a non-invasive way of delivering heat to kill tumours and thus is a form of Ablation.

Go to: Ablation as a cancer treatment

Focal Laser Ablation is used in the USA 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 number of Laser Prostate Centers in America.

Ablation, cryoablation, HIFU and prostate cancer in the UK - pathetic

Back in 2004, in icon magazine we briefly covered the news of this ’breakthrough’ therapy called HIFU, a form of Ablation. 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. They wrote to me (Chris Woollams) asking if I would look into the treatment and support it. I did more. I have ’Championed’ it for the men of Britain!

Open quotesIn Kentucky, over 1,000 men have been treated in the last few years - nerve damage is avoided,  incontinence occurs in less than 5% of casesClose quotes                                                                           

In its simplest form, private clinics in Europe started using Ablation at that time, 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.

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

By 2009 Clinical Trials 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.  

Go to: Worldwide HIFU Centres 

Three independent centres were launched in the UK about 4 years ago in Southampton, London and Newcastle. They said they would use ablation and cryoablation for prostate cancer. Their e mail was: https://www.ablationforcancer.co.uk/cryoablation.html - Frankly, I've never known anyone use them. Worse they seem to have ceased rading.

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, although some German clinics talk about 100% success in terms of 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.

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), although, judging by results with CANCERactive patients, Ablation can be as effective and considerably less expensive. Ablation in Germany can cost 6,000-8,000 Euros; HIFU in America $25,000. In the UK, you can have ablation (heat) or cryoablation (using temperatures of -40) - 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 1,000 patients with HIFU. 

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

Go to: Dr Pugach Free Webinar on HIFU

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

Frankly, the UK is being left behind.

Ablation or 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 days of 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 on 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?

Poor - very poor. You can try UCL. You might be better to use the location finder above, or to contact somewhere like Klinik St Georg in Germany for Ablation, or talk to providers in the USA. This is the future of prostate treatment today and the UK doesn’t really have it.

Frankly, we tell people about Germany, and about Louisville, Los Angeles and Houston in America and what they offer, the options in the UK are so dire.

But there is no practical reason the UK should lag - UKHIFU Limited ccould provide hospitals and clinics with HIFU technology on a for-profit basis, using the Sonablate 500 from Misonix and Focus Surgery in the USA.  Misonix Limited owns a 60% share of UKHIFU Ltd - www.ukhifu.co.uk

British men are being robbed of a highly effective treatment available to American males.

 

 

HIFU - an effective treatment for prostate cancer
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