SCCA now offers HIFU — a noninvasive, nonionizing ultrasonic treatment for prostate cancer

When Seattle Cancer Care Alliance (SCCA) launched its high-intensity focused ultrasound (HIFU) program last year under the leadership of urologic oncologist, George Schade, MD, it became the only medical center in Washington state to offer the procedure.

Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Ultrasound A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen. A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram). Ultrasound may be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures, such as biopsies. Also called ultrasonography.
George R. Schade, MD
George R. Schade, MD

Now, HIFU is finally gaining traction in the U.S. after a long history of use in Europe and Asia and FDA approval in 2015. As an HIFU expert, Dr. Schade has been researching next generation HIFU technologies for more than 10 years, most of that time with engineers at the University of Washington’s Applied Physics Lab.

Because it is noninvasive and uses non-ionizing sound waves that have fewer side effects, HIFU is popular among patients who increasingly seek this therapy over surgery and radiation. Insurance coverage is also improving, Dr. Schade says. Medicare and some private payers now cover the procedure.

HIFU: Leading-edge prostate treatment

HIFU uses a transrectal approach to target the prostate with a high-intensity beam of sound energy. The transducer concentrates ultrasonic energy onto a small area of tissue and destroys it with heat. Outside that area, energy levels are low and the tissue is unharmed.

At SCCA, Dr. Schade has access to the most advanced HIFU technology available — the Focal One. This device has several features, including:

  • A greater range of depth: The Focal One has a greater maximum and shorter minimum depth. The expanded range benefits patients with larger prostates. It eliminates the need for hormone therapy or transurethral resection to shrink the prostate prior to HIFU treatment. A shorter minimum depth also enables the treatment of tumors that lie close to the rectal wall.
  • Post-treatment contrast-enhanced ultrasound: An ultrasound with contrast performed after treatment highlights blood flow through the prostate. The ablated section shows up as a black hole. If there are any bright spots in the targeted area, Dr. Schade can apply additional HIFU treatment to destroy the entire tumor.

HIFU is an outpatient procedure that takes about two hours. “Recovery is usually quick,” says Dr. Schade. “The most common short-term side effect is swelling of the prostate. Patients go home with a catheter to help them urinate until the swelling subsides, which takes about a week.”

Precision tumor mapping using MRI imaging

Another feature of HIFU is MRI fusion, which uses an MRI image uploaded to the HIFU device. During the procedure, the device performs a 3D ultrasound scan of the prostate and combines it with the MRI image. This picture allows Dr. Schade to precisely plan treatment to target the tumor and a border area around it.

The success of tumor mapping in HIFU relies heavily on the quality and interpretation of MRI images. For this, Dr. Schade looks to SCCA’s radiology team, who have access to the latest MRI equipment and protocols. They also have extensive expertise annotating images.

Throughout the procedure, Dr. Schade continuously monitors progress. “The prostate might move a bit or shrink during the procedure,” he says. “We watch closely and pause to adjust the treatment plan as needed.”

Modern HIFU reduces sexual and urinary side effects

Compared with surgery and radiation therapy, HIFU reduces long-term side effects, including:

  • Decreased sexual function: Among men who had normal sexual function before treatment, about 85% who received HIFU retained sexual function after HIFU versus 40% to 80% after surgery. For radiation therapy, the percent of men who retain sexual function declines over a three- to four-year timeframe. Once recovered, HIFU-treated patients do not typically experience non-age-related decline in sexual function.
  • Urine leakage: Rates of urine leakage following treatment are lower (1%) with HIFU than both radiation therapy (2% to 3%) and surgery (10% to 15%).

The risk of urethral stricture and fistula is exceedingly low with modern HIFU therapy, compared with older HIFU technology, Dr. Schade notes.

Prostate cancer outcomes with HIFU

Patient outcomes have been difficult to measure, Dr. Schade says. “Prostate cancer is slow-growing and technologies are changing rapidly,” he says. “We don’t currently have any randomized trials comparing outcomes between HIFU, surgery and radiation therapy. But based on what we know, we think that cancer control with HIFU is similar to what we would expect for surgery and radiation.”

Currently, surgery and radiation are the standard of care for the treatment of localized prostate cancer, but Dr. Schade expects that will change with more data. A patient registry in Europe and early plans for similar registries in the U.S. may provide the data needed to establish HIFU outcomes.

Criteria for HIFU  

Eligibility criteria for HIFU includes:

  • Gleason score of 6 or 7
  • Single focus
  • Unilateral prostate cancer

HIFU is also an option for men who have localized recurrent prostate cancer after radiation. However, calcifications can block sound waves and may be a contraindication to HIFU if they are near the tumor.

Prostate cancer care at SCCA

Dr. Schade evaluates patients for HIFU carefully to ensure they are good candidates. As part of the patient evaluation, he typically performs a repeat biopsy and MRI.

“I’m finding that many men who are initially interested in HIFU have a higher-grade cancer or more extensive involvement of the prostate than the original tests showed,” he says. “In cases where we need to treat a larger area of the prostate, it usually makes more sense to recommend surgery or radiation, since we have more data supporting it.”

SCCA offers deep expertise in all types of prostate cancer treatments, including surgery and radiation therapy. Patients receive a personalized treatment plan and comprehensive, coordinated care.

Physicians at SCCA’s Prostate Oncology Center, located at UW Medical Center – Montlake, are available to consult with community oncologists to discuss treatment options.

For patient referrals contact:

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Eligibility criteria In clinical trials, requirements that must be met for a person to be included in a trial. These requirements help make sure that participants in a trial are similar in terms of specific factors. In clinical trials, requirements that must be met for a person to be included in a trial. These requirements help make sure that participants in a trial are similar in terms of specific factors such as age, type and stage of cancer, general health and previous treatment. When all participants meet the same eligibility criteria, it is more likely that results of the study are caused by the intervention being tested and not by other factors or by chance. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends. Ultrasound A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen. A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram). Ultrasound may be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures, such as biopsies. Also called ultrasonography. Gleason score A way of describing prostate cancer based on how abnormal the cancer cells in a biopsy sample look under a microscope and how quickly they are likely to grow and spread.

A way of describing prostate cancer based on how abnormal the cancer cells in a biopsy sample look under a microscope and how quickly they are likely to grow and spread. Most prostate cancers contain cells that are different grades. The Gleason score is calculated by adding together the two grades of cancer cells that make up the largest areas of the biopsied tissue sample. The Gleason score usually ranges from 6 to 10. The lower the Gleason score, the more the cancer cells look like normal cells and are likely to grow and spread slowly. The Gleason score is used to help plan treatment and determine prognosis (outcome).