High intensity focused ultrasound to treat prostate cancer shows initial success

By Dr. Ananya Mandal, MDApr 17 2012

A new tumor treatment that involves heating it with highly focused ultrasound, may mean men with prostate tumors can be treated without an overnight stay in hospital and avoiding the distressing side effects associated with current therapies.

A new study has found that focal HIFU, high-intensity focused ultrasound, provides the 'perfect' outcome of no major side effects and free of cancer 12 months after treatment, in nine out of ten cases. Traditional surgery or radiotherapy can only provide the perfect outcome in half of cases currently.

Prostate cancer is the commonest cancer in men with more than 37,000 diagnoses each year approximately 10,000 deaths. Current treatments include surgery to remove the whole prostate or radiotherapy. Both of which can effectively treat the cancer but often cause side effects such as incontinence and impotence. However in many men prostate cancer will not progress to a life threatening disease meaning that radical treatment risks side effects unnecessarily. For this reason, research is now focused on reducing side effects.

Focal HIFU involves careful selection of tumors, as small as a grain of rice, within the prostate gland and targeting them with highly focused ultrasound to heat them and destroy them. The advantage over previous HIFU and other treatments is that damage to surrounding tissue is minimized, meaning there are far fewer side effects.

In the study published in the journal Lancet Oncology, 41 men were treated with focal HIFU. After 12 months, none were incontinent and one in ten suffered impotence. The majority, 95 per cent, were free of cancer after 12 months.

The National Institute for Health and Clinical Excellence will say in new guidance next week that the treatment is safe and effective and larger scale trials should go ahead. A larger trial is already recruiting patients and men interested in the treatment should speak to their cancer doctor or GP about being referred, experts said.

Dr Hashim Ahmed, who led the study at University College London Hospitals NHS Foundation Trust and University College London, said, “This changes the paradigm. By focusing just on the areas of cancer we reduce the collateral damage to surrounding tissue. Our results are very encouraging. We’re optimistic that men diagnosed with prostate cancer may soon be able to undergo a day case surgical procedure, which can be safely repeated once or twice, to treat their condition with very few side-effects. That could mean a significant improvement in their quality of life. This study provides the proof-of-concept we need to develop a much larger trial to look at whether focal therapy is as effective as the current standard treatment in protecting the health of the men treated for prostate cancer in the medium and long term.”

He said, “These results will encourage more physicians to look at it more carefully. If men are interested in this concept they should speak to their cancer doctor or their GP. The next step is a large scale randomized controlled trial. This needs to be evaluated in a timely way so men can benefit.”

The research program is led by Professor Mark Emberton, of UCL and UCLH. He said, “Focal therapy offers harm reduction – it is a strategy that attempts to redress the balance of harms and benefits by offering men who place high utility on genito-urinary function an alternative to standard care. In fact, the concept is not new - tissue preserving strategies have been used successfully in all other solid organ cancers such as breast cancer by offering women a lumpectomy rather than mastectomy.”

Professor Gillies McKenna, director of the Medical Research Council and Cancer Research UK Gray Institute for Radiation Oncology and Biology, added, “Clinical trials, like this one supported by the MRC, are a fantastic tool for telling us whether experimental new treatments are likely to be effective in the clinic. If these promising results can be confirmed in a randomized controlled trial, focal therapy could soon become a reasonable treatment choice for prostate cancer alongside other proven effective therapies.” The research was funded by the MRC, the Pelican Cancer Foundation and St Peter’s Trust.

Jacqui Graves, Interim Head of Healthcare at Macmillan Cancer Support, said, “We welcome any research that shows early signs of improving the outcomes of treatment for prostate cancer patients. Significant reduction in the likelihood of common side effects, such as incontinence, will enable men to recover better and go on to lead good quality lives. We hope that a larger trial will be supported to ensure that the UK achieves the best outcomes for men affected by prostate cancer.”

Owen Sharp, Chief Executive of The Prostate Cancer Charity said, “We welcome the development of any prostate cancer treatment which limits the possibility of damaging side effects such as incontinence and impotence. These early results certainly indicate that focal HIFU has the potential to achieve this in the future. However, we need to remember that this treatment was given to fewer than 50 men, without follow up over a sustained period of time. We look forward to the results of further trials, which we hope will provide a clearer idea of whether this treatment can control cancer in the long term whilst ridding men of the fear that treating their cancer might mean losing their quality of life.”