High Intensity Focused Ultrasound or HIFU is the newest treatment for prostate cancer.

The newest ablative therapy is High Intensity Focused Ultrasound (HIFU). HIFU is a sophisticated, technical system that precisely directs energy only to the prostate cells. This technology can be compared to a magnifying glass that focuses the sun’s rays to ignite a piece of paper.  A hand placed between the magnifying glass and the paper does not get hot.

So too with HIFU, the normal tissues are cool, while the “significant” cancer is treated with the heat of focused ultrasound. By combining the image from a 3T MRI and HIFU system, we are able to spare the nerves and vessels that maintain erection, continence, ejaculatory function and a large portion of the prostate gland.  This produces a very rapid recovery in days, rather than weeks or months.

Focal Therapy, it's like taking care of the bad spot in the apple instead of throwing the whole thing away.

When we can distinguish “significant” prostate cancer from non-aggressive prostate cancer, ablative treatment options can be considered. When minimally invasive ablative therapy is used, it can treat the entire prostate gland or just the area with the known disease. Treating only the “significant” prostate cancer is known as focal therapy. Focal therapy eliminates the aggressive cells without destroying the rest of the prostate. This minimizes the potential for urinary incontinence or sexual dysfunction.

Focal prostate treatment is similar to the advancing technology for breast cancer. Today, lumpectomy has largely replaced the radical mastectomy.  Another way of thinking about focal treatment is to consider an apple with a bad spot. Rather than tossing the whole apple, only the bad spot is removed.

What does it mean when we put a patient on Active Surveillance?

In some cases, when a non-aggressive prostate cancer is diagnosed active surveillance is the appropriate treatment option. It is considered a treatment since it requires careful monitoring and follow-up. PSAs, digital rectal exams, imaging studies and prostate biopsies are routinely scheduled. If progression of the disease is identified other treatment options should be considered.

This type of surveillance is recommended only in cases of prostate confined, low grade, low volume cancers.  Only men who are committed to this type of treatment plan should be considered for active surveillance. Some men who initially decided on active surveillance change course and opt for another treatment because of the rigors of follow up or because they are uncomfortable with the  knowledge that they have a cancer and want to do something more.

What is "significant" prostate cancer?

What is “significant” prostate cancer? Genetic research has concluded that cancers, found in the prostate, are not all life-threatening. The life-threatening cancers are referred to as “significant” cancer and do require treatment.

The ability to differentiate the aggressive, significant cancer from non-aggressive cancer opens up more treatment options including focal ablative therapy. Ablative therapy can treat the entire prostate or just the area(s) with the aggressive cancer cells. If treatment is directed only to the aggressive cells it is referred to as focal therapy. Focal therapy eliminates the aggressive cells without destroying the rest of the prostate. This minimizes the potential for sexual dysfunction and urinary incontinence.

 Focal prostate treatment is similar to the advancing technology for breast cancer. Today lumpectomy has largely replaced the radical mastectomy. Another way of thinking about focal treatment is to consider an apple with a bad spot. Rather than tossing the whole apple, only the bad spot is removed.

3T MRI, what's that?

Magnetic resonance imaging, MRI, is an excellent study that does not use radiation. It produces images of organs. A newer MRI known as the 3-Tesla, or 3T, uses a more powerful magnet and can be used to provide us with a better image of the prostate. The 3T MRI actually looks inside the prostate and allows us to visualize down to the cellular level. This allows us to see the development of cancer at its very early stage. We then have an opportunity to do targeted biopsies so that we can determine if it is a cancer that needs to be treated. If the 3T MRI is negative, a prostate biopsy may not be necessary.

PSA and PCA3

Prostate cancer is second, only to lung cancer, as the cause of cancer-related deaths in men. Roughly 250,000 new cases were diagnosed in 2013. Approximately 34,000 men will die annually from this disease.

PSA blood testing has raised the awareness of prostate cancer. It is a very sensitive test that determines activity with the prostate; however a high PSA may be indication of an enlarged, benign prostate. Therefore PSA results do require further testing to in order to diagnose prostate cancer.

New technology is changing the way we think about the treatment of prostate cancer. PCA3 is a urine test that is very specific in its ability to identify prostate cancer. PCA3 is a protein produced in normal prostate cells, however when malignancy is present, the amount of PCA3 in the urine is much higher. This is a FDA approved test and is a welcome noninvasive test.