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Focal High-Intensity Focused Ultrasound Ablation for Intermediate-Risk Prostate Cancer

Recently, following treatment with focal high-intensity focused ultrasound (HIFU) at the UCSF Prostate Cancer Center, a 59-year-old man with unfavorable intermediate-risk prostate cancer and multiple comorbidities was discharged the same day and recovered well. The urologic surgical oncology team has performed an average of five focal HIFU procedures a month since the device was installed last year, offering patients a new minimally invasive treatment option. The team has extensive experience with focal cryoablation, and the addition of HIFU provides a complementary option.

“We favor treating prostate cancer in a patient of this age and risk level rather than active surveillance,” said UCSF urologic oncologist Hao Nguyen, MD, PhD, who performed the procedure and co-directs the focal ablation program with urologic cancer surgeon Katsuto Shinohara, MD. “Focal therapy could be an ideal approach for well-selected patients in this risk group.”

Challenging case with multiple comorbidities

The patient was in remission from lymphoma when diagnosed with prostate cancer, with a Gleason score of 4+3. He had previously undergone multiple abdominal surgeries, including a colostomy and a nephrectomy, to treat a gunshot wound. He was also on an anticoagulant due to a history of blood clots.

Because of this complex medical history, the patient came to UCSF for consultation. Urologic cancer surgeon Peter Carroll, MD, MPH, discussed multiple treatment options with the patient, based on the increased risk of complications from his bowel surgeries for the gunshot wound and his ongoing use of anticoagulants. Radiation was not his first choice because of its potential to compromise any future lymphoma treatment. Carroll referred the patient to Nguyen for focal therapy.

Imaging showed that the tumor’s size and location were favorable for focal therapy, and Nguyen performed a prostate tissue ablation with MRI-guided HIFU. “We ablated the tumor with HIFU and preserved the rest of the prostate,” Nguyen said.

The patient was discharged that day and recovered well, maintaining his sexual and urinary functions. “We will continue to follow up with him to monitor for disease recurrence,” Nguyen added.

Focal HIFU: efficient and effective

According to Nguyen, two physical mechanisms occur during focal HIFU application:

  1. HIFU waves induce sharp temperature increases within a few seconds. This causes tissue coagulation and leads to irreversible tissue damage through coagulative necrosis. The surrounding tissue is spared from destruction due to a steep drop in temperature.
  2. The HIFU waves’ negative pressure on the targeted tissue causes cavitation bubbles inside the targeted cells. The sudden collapse of these bubbles can generate up to 30,000 bars of pressure, causing tissue damage.

“HIFU takes about an hour to perform,” Nguyen said. “There is no blood loss, and patients can go home the same day without restrictions.” Because the energy is applied only to part of the prostate, the procedure has a lower risk of side effects compared with whole gland treatment.

Precision medicine for prostate cancer

HIFU is a valuable tool that makes it possible to deliver precision care to every patient based on the complexity of each case.

“We believe prostate cancer is a spectrum of diseases from low to high risk,” Nguyen said. “So we want to offer precise treatment that’s tailored to the patient’s disease and health background. Focal HIFU was the best option for this patient.”

Cancer research and treatment take place within the UCSF Helen Diller Family Comprehensive Cancer Center.

To learn more

UCSF Prostate Cancer Center

Medical oncology phone: (415) 476-4616 | Fax: (415) 353-7107

Surgical oncology phone: (415) 353-7171 | Fax: (415) 514-6195

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UCSF Urologic Surgical Oncology Clinic

Phone: (415) 353-7171 | Fax: (415) 353-7093

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