High-Intensity Focused Ultrasound Targets Prostate Cancer

Among the many health issues that men will face during the course of their lives, prostate cancer is one of the most prevalent. So far in 2023, the American Cancer Society has estimated that just over 288,000 new cases have been diagnosed and almost 35,000 men have lost their lives. In light of these sobering statistics, Gottlieb Memorial Hospital has added a powerful, new tool to help better treat prostate cancer in a targeted fashion, also known as focal therapy.

We spoke with Gopal Gupta, MD, an expert in urologic oncology and specialist in focal therapy for prostate cancer, about the addition of high-intensity focused ultrasound (HIFU) to treat prostate cancer. "HIFU is the newest FDA-approved treatment for prostate cancer that can help select men everywhere," says Dr. Gupta.

What is high-intensity focused ultrasound?

HIFU is a minimally invasive procedure that precisely targets cancerous tissue on the prostate. Essentially, these tissues are being burned away with high-frequency sound waves. An ultrasound probe is inserted into the rectum and the sound waves generate heat, killing just the cancer cells.

Gottlieb Memorial Hospital is now providing robotic HIFU. High-resolution images are combined with biopsy data and real-time ultrasound imaging to provide unparalleled visualization of the cancer in 3D. With this view, a physician can ablate only the diseased portion of the prostate. Called focal therapy, this procedure minimizes the damage to surrounding tissue (including important tissue, such as nerves and blood vessels). Not only does this speed up recovery, but it also decreases the risk of urinary incontinence and erectile dysfunction.

Patients can think of focal therapy as similar to a lumpectomy. This procedure removes only the diseased tissue from the breast of a woman with breast cancer. In the case of HIFU, physicians are doing the same thing, but with high-frequency sound waves.

High-intensity focused ultrasound is an alternative treatment for prostate cancer

When a man is diagnosed with prostate cancer that hasn't spread beyond the prostate, they usually have three options. The first is patient waiting and active surveillance. Many times, prostate cancer grows slowly and is nonaggressive. If caught early enough, patient check-ins with doctors may be the primary treatment option.

The second option is surgical removal of the prostate using a minimally invasive robotic assistance, while the third option is radiation therapy that usually requires many rounds of therapy over a long period of time. These options have been the standard of care for prostate cancer for many years.

HIFU provides a new and different alternative treatment strategy. Instead, of whole gland surgeries or treatments that can take months and have side effects, HIFU is a minimally invasive procedure that requires no incisions. And instead of patients needing to come back over an extended period of time, after a HIFU procedure they usually go home the same day. It is a precise and effective treatment option that can help select men with prostate cancer. If the prostate cancer is to come back after HIFU, most men still have the option for more invasive therapy such as surgery or radiation.

"What has made focal therapy so exciting is our ability to accurately see the area of prostate cancer using prostate MRI," says Dr. Gupta. "In addition, we are able to biopsy the areas of interest and have a great sense of how big, where and how aggressive the cancer is." “Now we have added HIFU to be able to target these areas of cancer to minimize treatment side effects”

What are the side effects of high-intensity focused ultrasound?

Like all procedures, HIFU can have side effects for the patient. These can include:

• Pain. After the procedure, pain may occur between your testicles and rectum.
• Blood in your urine. Blood or small pieces of prostate tissue in your urine can last for a few weeks.
• Erection problems. It's possible you might have difficulty having or keeping an erection. This usually goes back to normal fairly quickly.
• Urine infection. Signs of an infection include pain while passing urine or feeling cold or shivery. If you have these symptoms, contact Gottlieb Memorial Hospital immediately. Severe infections can be life threatening.
• Problems passing urine. Prostate swelling can occur after HIFU which can block the urethra. Tell your doctor right away if you can't pass urine at all.
• Infection in your testicles. Although rare, an infection in the testicles can occur. Some of the symptoms include swelling and/or pain or tenderness in your testicles. Usually, antibiotic tablets are all that's needed.

Who qualifies for high-intensity focused ultrasound?

HIFU is used to treat a single tumor or part of a large tumor. It is not meant for those whose cancer has spread beyond the prostate. The ideal candidate has early stage, low-grade prostate cancer that is still within the prostate. It also should be visible on an MRI or ultrasound.

In general, your physician will recommend HIFU if your cancer:

• is contained inside the prostate, known as localized prostate cancer.
• is just breaking through the covering of the prostate, known as locally advanced prostate cancer.
• has come back after earlier treatment, also known as salvage treatment.

If you qualify for HIFU, the treatment will either focus on the whole prostate gland or specific areas of the prostate.

There are also a few limitations to HIFU. "One such limitation is prostate volume or size. If patients have large prostates and anterior tumors, the energy may not reach anterior enough to provide effective treatment and negative margins," says Dr. Gupta.

Why choose Gottlieb Memorial Hospital?

The treatment(s) your doctor recommends will depend on many factors. At Gottlieb, our physicians have vast experience with prostate cancer. The Urology department has one of the most comprehensive and advanced teams in the nation, with primary and specialty care offices conveniently located throughout Chicago’s western and southwestern suburbs.

Recently, prostate biopsy practice and minimally invasive urologic surgery treatments, including HIFU, has been transferred to Gottlieb Memorial Hospital. We are very excited to offer all of our diagnostic and treatment options at Gottlieb.

Gopal Gupta, MD, is a urologic surgeon at Loyola Medicine who received his B.S. in Biological Chemistry from the University of Chicago in 1996 and his M.D. from the University of Illinois at Chicago in 2002. He then performed his residency in urologic surgery at the University of Maryland Medical Center until 2008. Between 2008 and 2011, Dr. Gupta completed a fellowship in urologic oncology at the National Cancer Institute in Maryland.

His primary clinical research interests pertain to bladder, kidney and prostate cancer. Dr. Gupta performs minimally-invasive surgeries using the DaVinci Robotic Surgery platform. His clinical interests are to push the cutting edge of technology while optimizing cancer outcomes.

Book an appointment today to see Dr. Gupta or another Loyola physician by self-scheduling an in-person or virtual appointment using myLoyola.