High-Energy Ultrasound Cooks Prostate Tumors
May 3, 2000 (Atlanta, Ga.) -- An
experimental technique that literally puts the heat on prostate cancers has
worked for virtually all of a select group of patients.
The treatment is known as high intensity
focused ultrasound (HIFU), and it uses a probe inserted in the rectum to
produce temperatures near the boiling point to kill cancer cells.
So far, the approach has been used on about
440 patients in a four-year study performed by Christian Chaussy, MD, a German
urologist. These patients, because of their age or health problems, were not
candidates for surgical removal of the prostate -- a walnut-size gland at the
base of the bladder that is a leading site of cancer in men. However, since
their disease hadn't spread throughout the gland, they were eligible for
Chaussy says that of the 440 men treated,
78% had a cancer-free test afterward and the rate improved to 96% with a second
HIFU treatment. "It looks very much that we might have [an option for a
cure] with this technique," Chaussy says. His findings were presented at a
meeting of urologists here this week.
However, there are some caveats to the
procedure. First, HIFU hasn't been around long enough to compare it with
surgery -- still the gold standard for prostate cancer. Second, there are side
effects including a high rate of urinary tract infections, some incontinence,
and a rare fistula -- in effect a hole burned through the prostate into the
On the positive side, PSA tests, the most
common method used to indicate the presence of disease, dropped dramatically in
the majority of the patients treated. Recovery time also was quick, typically
less than one day in the hospital.
Chaussy says only about
half the patients were potent after the 90-minute procedure, which delivers
heat at a series of focal points controlled by a computer. However, the
researcher says the sexual function rate may be increased to about 90% if the
patient's disease is on just one side of the prostate. Then only that side is
treated, but Chaussy says that means there's a slightly higher chance the
disease may return.
Currently, only about
25% of patients undergo surgery or radiation treatment for their prostate
cancers with all the associated downsides. Others try hormone therapy, which
also has side effects, or simply wait and watch the tumor. Chaussy believes for
some men who don't want other treatments or can't tolerate them, HIFU appears
"We can tell him
what we have available is a technique which has quite good results over a
follow-up of four years. That is not comparable to the statistics, which you
have with radical [surgery]," Chaussy says.
In fact, other surgeons
contacted by WebMD were skeptical of the approach. Patrick Walsh, MD, chief of
urology at Johns Hopkins Medical Institutions, says HIFU can't compete with
surgery until it can bring PSA test scores down to undetectable levels.
However, Chaussy insists that testing tissue samples directly from the gland
are a better predictor of cure.
While acknowledging that
the approach may work for some, K.C. Balaji, MD, says he would tend to
recommend surgery. "Depending on the [severity] ? I would probably have the
most curative solution, which would probably be surgery," he tells WebMD.
Balaji is director of urology oncology at the University of Southern Illinois
School of Medicine.
Meanwhile, the HIFU
approach is not only being investigated in Europe but also here in the U.S. at
hospitals in Washington, Houston, and San Francisco.