HIFU therapy for prostate cancer (PCa)

There are numerous treatment options available for the potentially curable stages of prostate cancer. A radical prostatectomy (complete surgical removal of the prostate) is the most common form of treatment recommended in Germany. However, it is now known that only very few men benefit from having had this type of surgical procedure. Patients aged 65 years and above, which is the age group most frequently diagnosed with prostatic carcinoma, rarely benefit from a radical prostatectomy.

Also, in the case of those patients where a low risk prostatic carcinoma has been determined, there are hardly any benefits to be gained from a radical removal of the prostate.

The HIFU principle using the Sonablate 500

The Clinic for Prostate Therapy has therefore specialised in a new, minimally invasive treatment concept for prostate cancer: HIFU therapy based on the Sonablate 500 principle. HIFU stands for High Intensity Focussed Ultrasound. The procedure uses energy-rich bundled ultrasound. This is different from the ultrasound used for ultrasound imaging, as it is able to produce heated areas with pinpoint accuracy in a predetermined tissue area. The corresponding tissue area can be heated up to between 90°-100°C over a maximum period of 3 seconds and this destroys the tumour cells.

A comprehensive consultation regarding possible risks is conducted before every treatment.
In an HIFU procedure, the transducer head emits highly focused, intensive ultrasound.
The schematic drawing explains how the high-intensity ultrasound functions.

Treatment

The ultrasonic probe is placed directly in front of the prostate via the rectum, so that the energy can be applied directly onto the target organ. A special cooling system prevents the surrounding structures (above all, the wall of the rectum) from over heating. In this way, the entire prostate can be treated so that all tumour cells are destroyed. Surgery is not required here. In this procedure, the sphincter muscle is identified and is not treated, so that incontinence is unlikely. Depending on the location of the prostate tumour, it is possible to protect the potency nerves so that impotence can be avoided. In the case of small tumours which can be precisely located using high-resolution MRI, focal therapy is also considered where applicable. This means that only the area of the prostate where prostatic carcinoma has been detected will be treated. Here, in some cases, the function of the prostate can be fully maintained (including ejaculation). Following treatment, a catheter is inserted via the urethra, as temporary swelling of the prostate occurs. This catheter can then be removed after one or two weeks. However, patients can leave the clinic the day after HIFU therapy.

If, in the case of prostatic carcinoma, there is also an enlargement of the prostate, a reduction in the prostate volume can be advisable prior to HIFU treatment. As a rule, this can be carried out in a very gentle manner using the Greenlight laser. As is the case with all tumours, close monitoring is also required after therapy in the case of prostatic carcinomas. It is not only a way of monitoring the success of the treatment, but also allows early recognition of the possible side-effects of the treatment which are usually easy to cure. As a rule, we recommend that patients have a follow-up examination after one month, then every three to six months during the first year following treatment.