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 HIFU.
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 rectum.
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 promising.
"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.
- A German researcher reports another option may become available to treat patients with prostate cancer, joining standard treatments like surgery, radiation, and hormone therapy. The new technique uses a probe inserted into the rectum so cancer cells in the nearby prostate gland may be heated and killed with ultrasound.
- A recent study showed nearly 80% of the 440 men treated had a cancer-free follow-up test, or biopsy. Nearly all had a clear biopsy after a second treatment of high intensity focused ultrasound, or HIFU.
- Doctors still don't know how HIFU's results will compare to surgery, and some comment that they would still steer their patients to the surgical route.