St. Clair Hospital offering non-invasive prostate treatment
A surgeon at St. Clair Hospital in Mt. Lebanon recently performed the first HIFU procedure for prostate cancer at St. Clair using advanced new ultrasound technology. This makes St. Clair the first health-care system in the Pittsburgh region to offer the technology.
HIFU stands for High-Intensity Focused Ultrasound, and the robotic procedure offers a new, non-invasive alternative to traditional prostate cancer surgery for many patients.The Focal One HIFU procedure also offers the added benefits of no cutting and no radiation needed for patients.
Dr. Kevin Bordeau, urologic surgeon with St. Clair Medical Group, performed the HIFU procedure at St. Clair using high-intensity ultrasound waves precisely focused on cancerous prostate tissue. This creates localized heat known as ablation that destroys the cancerous cells while leaving healthy tissue around the tumor intact.
“There are various ways to ablate cancer, and it’s a way of trying to do it in the less invasive way to try to minimize side effects,” explains Bordeau.”This high-intensity focused ultrasound has been around for probably 30 years in some form as a way of doing this, but what I felt was so attractive about the newer technology was that it’s been combined with the newer imaging techniques we have for prostate cancer.”
Surgeons use that MRI and PET imaging to help guide them to the specific tumor tissue. “There’s a special type of PET scan for prostate cancer called a PMSA PET scan, and these are relatively new in the world of prostate cancer,” says Bordeau. “MRI has probably been around really actively for the last five to seven years where it’s gotten more normal in the use and diagnosis and treatment of prostate cancer, and so with the improvement in imaging technology came the ability to focus this high-intensity ultrasound beam to ablate only certain areas of the prostate that contain cancerous tumors.”
He adds that’s what makes this technique so attractive because it does much less harm to everything around the tumor, leading to fewer side effects and down time.
“You can now go in and ablate these things. There’s really no need to do any incision or any kind of radiation, and so it basically just kills the tumor in the prostate where it is, leaves the rest of the prostate behind. And by doing that, you can really minimize the side effects of treatment of prostate cancer.”
In a recent study, Focal One Robotic HIFU proved to have comparable results in prostate cancer cases while offering significantly lower negative impacts when compared to traditional prostate surgery. The study of more than 3,000 patients treated across 46 centers show the HIFU also produced better results for men’s urinary continence and erectile function compared to patients who underwent surgery. The benefit of only targeting the cancerous tissue is that it leaves less scarring in the prostate.
“That’s really the issue with radiation is that if you have radiation, then it can cause a lot of scarring which makes subsequent treatment more difficult if the cancer were to come back,” Bordeau says.”That’s one of the other potential benefits of this technology is that you can actually go in and use the ultrasound to treat areas even after the tissue has been radiated. You can treat the areas you still see on MRI.”
The HIFU procedure is done in a single session under general anesthesia and is non-invasive, requiring no incision or radiation. As a result, the risk of side effects such as incontinence and erectile dysfunction is low, and most patients experience minimal time away from work or leisure activities. As for who makes a good candidate for HIFU, Bordeau says the main criteria is a patient with a smaller amount of cancer. “Possibly cancers that are a little bit more aggressive, typically that are located on only one side of the prostate or potentially people who have had radiation and their cancer has come back,” he adds. “Or patients who are maybe a little bit older and not great surgical candidates.”
He also notes that prostate cancer comes in many varieties and that a common misconception is that all tumors are slow-growing.
“Some of it’s slow growing, some of it’s pretty aggressive,’ he says. “So this is really for the folks who are kind of right in the middle, because the people who have the slowest growing types of cancer often don’t need treatment at all, so we would watch those people. But the people with the more aggressive cancers, they would still need to probably have the prostate removed or radiated.”
He believes the HIFU procedure will mostly help patients who fall right in the middle. “And it’s not an inconsequential number of people, really,” Bordeou says. “If you look across the board, the number of people who are candidates for active surveillance, which means close observation or watching it, and the patient who are candidates for surgery or radiation… there are a pretty substantial number of people in the middle who may be good candidates for this.”