High-Intensity Focused Ultrasound (HIFU) Therapy
Teikyo University Hospital, Department of Urology
Cutting-edge Prostate Cancer Therapy
Teikyo University Hospital, Department of Urology
The prostate is a very important gland for the male sexual functioning and plays an important role in the regulation of urination and production of seminal fluid. The prostate gland is located right beneath the outlet of the bladder deep inside the male pelvis; and the urethra passes through the middle of it.
Prostate cancer, which develops in the prostate gland, is the most common cancer among men in Europe and in the United States; and it is also becoming very common among Japanese men. Previously, when cancer was confined to the prostate, then either a surgery to remove the entire prostate gland (curative radical prostatectomy) or external beam radiation therapy was carried out. However, both surgery and radiation therapy have many problems. They are highly invasive (cause enormous burden to the patientsf body), have potential complications at least to some extent, and require a long treatment period. Hence, a less burdensome, safer and short duration cancer treatment was sought.
Consequently, the department of urology at Teikyo University Hospital adopted the high-intensity focused ultrasound (HIFU) therapy for the first time within the 23 wards of Tokyo.
HIFU is a state-of-the-art therapy to treat early prostate cancer by emitting a computer-controlled beam of high-intensity ultrasound to the prostate.
Principles of HIFU
HIFU is a therapy to treat carcinoma located deep within the body by the use of ultrasound beams. Ultrasound has been used mainly for examination purposes in various fields of medicine. For example, it is used to inspect the conditions of the fetus inside a pregnant woman and to screen for gallstones in patients with abdominal diseases.
By converging the ultrasound beams to a focal point, it is possible to concentrate energy of high intensity to that point. By utilizing this technique, it is possible to destroy the targeted tumor while preserving the surrounding normal tissue. Currently, HIFU treatment is considered to be most effective in prostate cancer; however, applications to renal and pancreatic cancer, both of which are very hard to treat, are also being developed.
Treatment Method
A treatment probe is inserted through the anus and placed on the section where the ultrasound beams get focused at the targeted point. (Figure 4, 5) The structure of this probe is very similar to the diagnostic ultrasound probes used in transrectal prostate biopsy. By emitting high-intensity ultrasound beams from these probes and by focusing these beams to a small area, intense heat of 60 to 90 degrees Celsius is generated at this focal point. This heat destroys and causes death of all the tumor cells at the focal point. This focal point is moved gradually within the prostate gland by computer control to destroy the whole tumor. The treatment is performed in about 3 hours under the combined use of general and epidural anesthesia. At the end of the operation, a catheter is inserted into the bladder. The hospitalization period is typically 3 days.
Advantages of HIFU Treatment
HIFU is an innovative and cutting-edge treatment where it can control cancer for more than 80% of all cases treating localized (Cancer which has not spread to the surrounding organs, or non-metastatic cancer) prostate cancer.
The following points are the advantages of HIFU compared to surgery or radiation therapy.
- No incisions are made to the skin or the muscle.
- No bleeding while conducting the treatment and safer than surgery.
- Can be treated with a short hospitalization period.
- Patients can return to their usual routines immediately after their discharge from hospitals.
About Other Treatment Methods
Currently, either curative radical prostatectomy or radiation therapy is mainly carried out to treat early-stage prostate cancer.
The efficacy of curative radical prostatectomy is about 80 to 90, and is currently considered to be the most certain treatment method. The treatment that is covered by insurance is a surgery in which the abdomen is cut open and the whole prostate gland is removed. Because of this invasive treatment, not only a hospitalization period of approximately 3 to 4 weeks is needed; but also, blood transfusions might be needed because of bleeding during surgery and there are risks of developing complications such as urinary incontinence, impotence, rectal damage, urethrorectal fistula, and post-surgical pulmonary embolism. Generally, because this surgery involves lots of bleeding, the patientfs own blood is drawn and stored before surgery, to be used for transfusion at the time of surgery.
In a long-term basis, the efficacy of radiation therapy is not as effective as surgery; however, this treatment has been selected as first-line therapy when patients have chronic cardiac or respiratory illness, when risks of surgery is high, or when the patients were hesitant about having an operation. Hospitalization periods are usually lengthy and approximately 6 to 8 weeks long. Common side effects of radiation therapy are diarrhea while on treatment, radiation proctitis, and radiation cystitis. There are cases when even 5 to 10 years after the treatment, patients develop rectal ulcers and stenosis, and bleeding.
Complications of HIFU Treatment
HIFU has already been carried out in Japan, United States and in Europe. However, it also has its complications. Similar to abdominal surgery, 1 to 2% of patients develop a complication called urethrorectal fistula, in which a hole opens between the urethra and the rectum. When this happens, an artificial rectum is temporarily created and when the urethrorectal fistula gets cured (about 6 to 12 months later), this rectum is sealed. Moreover, occasionally HIFU treatment causes the urethra to narrow (urethrostenosis), in which case further endoscopic procedures to dilate the urethra is needed to be carried out.
Treatment Costs
A payment of 945,000yens (taxes included.) will cover all your hospitalization and treatment expenses for 3 days and 2 nights.
- Because it is not covered by insurance, patients are required to self-pay.
- Patients will be asked to pay the respective differences in quadruple room.
- All balances are due and payable in full at the time of discharge.
- A deposit of 200,000 yens is required on the day of admission. (This 200,000 yens is part of the total payment of 945,000 yens)
Contact
Teikyo University Hospital, Department of Urology
Tel 03-3964-1211
Email: urology@med.teikyo-u.ac.jp
