Urology Associates Debuts Treatment Option
Nashville-based Urology Associates has recently rolled out a new therapeutic option for select prostate cancer patients using high intensity focused ultrasound (HIFU) to target cancerous cells while sparing healthy tissue, nerves and urine flow to minimize side effects.
"It just received FDA approval in the United States about a year ago," explained Matthew Hassan, MD, a partner at Urology Associates who has been trained in the new technology. "We've had it available for about two months, and we're the only group in Tennessee offering this right now."
Matt Hassan, MD
While approved for the treatment of prostate cancer in Europe, Australia and Canada, the U.S. Food and Drug Administration approved the technology for "prostate ablation" in December 2015. The wording left some confusion about scope but also gave physicians the flexibility to use the technology for patients with prostate cancer. Available in Europe for more than a decade, HIFU has been utilized in more than 65,000 men around the world. The resulting data, Hassan said, has shown a track record comparable to cure and disease-free progression rates as is found with more aggressive therapies in patients with localized, lower to middle-grade prostate cancer.
Hassan explained the non-invasive outpatient procedure deploys ultrasound waves, precisely focused through magnetic resonance guidance, to heat diseased tissue to the point of destruction through ablation, while sparing healthy structures around the target area.
Diagnostic advances over the years have allowed physicians to find early-stage cancers, but Hassan said the next steps for treatment after discovery have been limited. Traditionally, the choice has been to undergo an invasive option with a significant risk of side effects or to 'wait and watch.' For men with low to middle-grade prostate cancer, Hassan said, "Prior to HIFU, you had to remove the whole thing or radiate the whole thing, but HIFU really permits us to treat part of the prostate and leave the part without the cancer untouched ... and therefore, you avoid a lot of the side effects of whole gland treatment."
He added with whole gland treatment, the concerns include urinary incontinence, impotence and long recovery times. "HIFU is much less invasive so the recovery time may be a weekend with very minimal, if any, impact on leakage or erection," Hassan noted. "The rate of any kind of incontinence or impotence is less than 1 percent with a partial gland treatment, and HIFU is the only partial gland treatment at this point in the U.S."
Hassan said the model for this type of focal treatment has been kidney cancer. "Now we rarely take the whole kidney out," he added of advances in treatment options. "This is our first foray into doing this for prostate cancer."
Hassan said he believes focal therapy will have a strong role in the future of prostate cancer. "The efficacy is very good. Dependent on the type of prostate cancer, the efficacy rates range from 80 to 95 percent cure rate," he said.
This treatment is limited to men with localized, early stage cancer and would therefore not be an option for those with metastatic or advanced cancer. Even in the primary group, Hassan said sometimes the prostate is too big to effectively be treated in this manner; and in other cases, the cancer is too aggressive. For those who meet the inclusion criteria, however, HIFU offers a viable option with significantly less fear of unwanted side effects.
"The thing I tell patients a lot is we're at a place where our diagnostics have outstripped our therapies," said Hassan. With HIFU, he continued, "We finally have the ability to pair up a treatment with the actual level of disease that exists."