HIFU

Indications

Application of HIFU in conjunction with prostate cancer

Nowadays, HIFU can be used as a primary therapy, in case of failure of radiation therapy, local recurrence of prostate cancer after surgery and as a repeat treatment after previous HIFU therapy.

Primary therapy

As a primary treatment, HIFU is an alternative therapy for patients who, as a result of side effects, advanced age or enhanced anesthetic risks, are not suitable to undergo radical prostatectomy.

Younger patients can be offered HIFU treatment if they have been informed in detail about the advantages and disadvantages of the method and have refused their informed consent for a surgical intervention. Mostly, the desire for fewer side effects is in the forefront.

Equally suited are patients with a so-called `incidental prostate carcinoma´, i.e. patients where carcinoma tissue was discovered within a TUR (transurethral resection) of the prostate.

HIFU after radiation failure

If prostate cancer reappears after radiation therapy, a radical prostatectomy is normally associated with high complication rates. The side effects observed in connection with HIFU treatment after failure of radiation therapy are normally lower.

Local tumor recurrence should, if possible, be determined previously via biopsy. Depending on the PSA value, a bone scan and, if applicable, a PET-CT examination should be performed to rule out metastatic disease. In view of possible pathological changes of the rectum as a late consequence of radiation, a protoscopy is advisable.

Repeat treatment after failure of HIFU treatment

One advantage of the HIFU method is the possibiity of repeating the treatment in case of tumor recurrence. After a second HIFU treatment, the incontinence rate (approx. 12%) and impotence (approx. 55%) are slightly higher than after a single treatment. The duration of treatment is usually far shorter in the case of a repeat HIFU, as the prostate has shrunk significantly as a result of the first treatment.

Palliative Treatment

Palliative therapy comprises treatment of an advanced or metastasized tumor, for which there is no longer a cure. It serves to diminish local tumor growth and to reduce local complications such as repeated hemorrhaging, bladder voiding disorders and hydronephrotic kidneys.