HIFU treatment (High-Intensity Focused Ultrasound), a type of focal therapy, is an innovative approach for treating intermediate-risk localized prostate cancer that is well-visualized on MRI. Although widely used globally, mainly in private clinics or within strict research frameworks, it remains relatively uncommon in Quebec and Canada. It is not yet recognized as a standard treatment and is not suitable for all patients. However, it is generating significant interest and questions. This article aims to explore what HIFU is, its potential benefits, and its limitations, to better manage patient expectations and provide an informed perspective on this treatment.

Medically reviewed by Urologist-Surgeon Dr. Thierry Lebeau on 06/20/2024

Focal therapy: An overview

Focal therapy aims to treat only the area of the prostate where the cancerous tumor is located, either by removing or destroying it. This method allows the preservation of the rest of the prostate, thereby reducing the risks of side effects such as urinary incontinence and erectile dysfunction. To achieve the best results, very precise patient selection is necessary, based on advanced techniques such as MRI and fusion biopsies.

Types of focal therapy

In addition to HIFU, other types of energy are also employed in focal therapy:

• Cryotherapy: Also known as cryoablation, this approach uses probes to freeze and destroy prostate cancer cells. Liquid nitrogen or argon is used to create extremely low temperatures, which kill cancer cells by freezing them.

• Photodynamic therapy (PDT): This technique combines a photosensitizing drug with a light source to kill cancer cells. The drug is activated by a specific light, causing a chemical reaction that destroys the cancer cells.

• Laser ablation: This method uses lasers to heat and destroy cancer cells. Laser fibers are inserted directly into the prostate to precisely target the affected areas.

What are the modalities of HIFU treatment?

HIFU treatment uses high-intensity focused ultrasound delivered from the rectum to the targeted prostate area. The procedure typically lasts between 1 to 3 hours, depending on the tumor’s size and location, and is performed under general or regional anesthesia. This intervention usually requires a short hospital stay. A urinary catheter is placed and is typically removed one to three days after the procedure. Generally, only one treatment is needed, but regular follow-ups are conducted to monitor the treatment’s effectiveness and detect any recurrence.

Who is it recommended for?

HIFU is not yet a standard treatment for prostate cancer. However, it is recommended for patients with an intermediate-risk prostate cancer, clearly visible on MRI, who have a life expectancy of at least 10 years. These patients often seek to preserve their quality of life, as focal therapy, including HIFU, reduces the risks associated with treatments such as radical surgery or radiotherapy. Regular post-operative follow-up is therefore crucial, including PSA tests, MRIs, and prostate biopsies.

Is it still under research protocol?

Focal therapy is still considered a recent technique and is not part of the standard treatments recommended by Canadian, American, or European guidelines. Hospitals offering this therapy, such as the McGill University Health Centre (MUHC) and the Jewish General Hospital in Quebec, do so within a strict research framework. Data from treated patients are recorded in a local and international registry (Focal Therapy Society) and are subject to long-term follow-up. These data are used for research purposes, which will eventually allow focal therapy to become part of standard treatments in the coming years.

Why should I not pay for this expensive treatment?

Although focal therapy is appealing, paying a high amount for this treatment in a private clinic does not guarantee the best results. The good, or even excellent, results reported in the scientific literature are the work of a dedicated multidisciplinary team of uro-oncology experts, who use advanced techniques to diagnose and treat cancer. Quality treatment requires high-quality MRI, precise biopsies, and analysis by specialized pathologists. Each case is discussed by a panel of specialists (urologists, radiologists, pathologists, radiotherapists, oncologists) to propose the best therapeutic option for the patient.

The success of the treatment depends on precise patient selection and the ability to manage potential complications, which is better ensured in an expert hospital center to avoid long-term sequelae or disease recurrence. For example, the scientific literature reports that analyzing MRI images of the prostate after focal therapy requires very specific expertise, which can only be obtained in expert centers.

In summary

HIFU as a focal therapy is a promising option for certain patients with prostate cancer. However, this treatment must be performed by experts under controlled conditions to ensure the best results and rigorous follow-up. For more information, discuss with your medical team to see if this option is suitable for your situation.