Men who are diagnosed with localized prostate cancer face a difficult task when deciding which treatment to select. There probably are more options for treating this disease than any other one affecting men or women. Sadly, the lack of good comparative studies means that doctors are not really sure which one is best for an individual patient. One of the options is called HIFU, which stands for High Intensity Focused Ultrasound. It is a minimally invasive treatment that directs sound waves to the prostate. This generates intense heat that is able to kill cancer cells. It has been used outside of the United States for many years, but currently it has not been approved for use within this country. Even so, some doctors in the United States will perform it by taking their patients to Canada, the Dominican Republic, the Bahamas, and Mexico. However, anyone wanting it will have to pay for it out of their own pocket because no insurance company will cover the cost at the present time. That amount is over $20,000.
Searching for information on this treatment will lead to both positive and negative results. Among the weaknesses is a lack of long term survival data, no well-done studies comparing it to other more established treatments, and limited reliable information about the short- and long-term side effects from validated surveys.
A new scientific paper does provide additional information worth noting. Dr. Viktor Berge and co-workers reported the findings from 359 men treated with HIFU at three centers in the United Kingdom. A second treatment was done in 36% because the cancer was not eradicated. It failed in 44% of these men. Of those who had low risk disease, 34% failed the first treatment.
Patients were asked to complete a written questionnaire before and after each treatment. They reported the following problems after the first treatment: Urinary tract infection (11%), narrowing of the urethra requiring treatment (14%), surgery for a urethral stricture (10%), and urinary leakage (30%). Of the men who did not leak urine after the first treatment, an additional 20% leaked urine after the second treatment. One limitation of the study is nearly one-third of the patients did not complete the survey. That could mean that these results underestimate the percentage of patients with some of these problems.
These data provide a better view of what to expect short-term with HIFU. Skeptics will view the results as very negative given the high rate of failures and the frequency of urinary problems. There still are no long-term survival results. For now, men considering this option should be aware of its limitations and ask themselves whether the advantage of a minimally invasive approach is worth the expense and side effects that occur. Keep in mind that many of the men who were treated in this study probably did not need any treatment at all because their cancer would never have harmed them. A better minimally invasive option is seed implantation (brachytherapy), which has fewer urinary problems and a lower recurrence rate. The ongoing studies being done in the U.S. should soon provide additional information about men undergoing this treatment. Until then, the negative aspects of HIFU appear to outweigh the positive.